Provider Demographics
NPI:1346319654
Name:HONG, ALICE (PT)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:
Last Name:HONG
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5635 TIMSON LN
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-7954
Mailing Address - Country:US
Mailing Address - Phone:770-623-6824
Mailing Address - Fax:770-623-6824
Practice Address - Street 1:4310 JOHNS CREEK PKWY
Practice Address - Street 2:100
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-6091
Practice Address - Country:US
Practice Address - Phone:770-814-2900
Practice Address - Fax:770-814-7790
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT003434225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist