Provider Demographics
NPI:1346299476
Name:DIMICCO, ALBERT J (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MR
First Name:ALBERT
Middle Name:J
Last Name:DIMICCO
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:48 MEDICAL PARK EAST DRIVE
Mailing Address - Street 2:SUITE 255
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35235
Mailing Address - Country:US
Mailing Address - Phone:205-838-3090
Mailing Address - Fax:205-838-6783
Practice Address - Street 1:48 MEDICAL PARK EAST DRIVE
Practice Address - Street 2:SUITE 255
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35235
Practice Address - Country:US
Practice Address - Phone:205-838-3090
Practice Address - Fax:205-838-6783
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ALPTH154225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51502562OtherBCBS
AL51524776OtherBCBS
AL51502562OtherBCBS
AL0774Medicare UPIN