Provider Demographics
NPI:1184040164
Name:PIERCE, ALICE (LAT, ATC)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:
Last Name:PIERCE
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5505 HAMSTEAD XING
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-7004
Mailing Address - Country:US
Mailing Address - Phone:919-368-5434
Mailing Address - Fax:
Practice Address - Street 1:5505 HAMSTEAD XING
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-7004
Practice Address - Country:US
Practice Address - Phone:919-368-5434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-13
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20352255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer