Provider Demographics
NPI:1376049635
Name:ALIAS, SHIJO
Entity Type:Individual
Prefix:
First Name:SHIJO
Middle Name:
Last Name:ALIAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1951 KING ARTHUR RD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19116-3837
Mailing Address - Country:US
Mailing Address - Phone:267-632-5797
Mailing Address - Fax:
Practice Address - Street 1:280 MIDDLE HOLLAND RD
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:PA
Practice Address - Zip Code:18966-4822
Practice Address - Country:US
Practice Address - Phone:215-322-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-04
Last Update Date:2018-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE011502225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant