Provider Demographics
NPI:1386651651
Name:NIXON, ALICIA A (PT BCB PMD)
Entity Type:Individual
Prefix:MRS
First Name:ALICIA
Middle Name:A
Last Name:NIXON
Suffix:
Gender:F
Credentials:PT BCB PMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3306 YELLOWKNIFE CIR
Mailing Address - Street 2:
Mailing Address - City:WIMAUMA
Mailing Address - State:FL
Mailing Address - Zip Code:33598-7126
Mailing Address - Country:US
Mailing Address - Phone:727-776-5542
Mailing Address - Fax:
Practice Address - Street 1:827 CYPRESS VILLAGE BLVD
Practice Address - Street 2:
Practice Address - City:RUSKIN
Practice Address - State:FL
Practice Address - Zip Code:33573-6838
Practice Address - Country:US
Practice Address - Phone:813-633-0669
Practice Address - Fax:813-633-0881
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2014-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT014787225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00065042OtherMEDICARE RAILROAD
FL8895007 00Medicaid
FLY6115OtherBLUE CROSS & BLUE SHIELD
FLY6115AMedicare ID - Type UnspecifiedMEDICARE #