Provider Demographics
NPI:1417196957
Name:KONEN, ALICIA P (PT)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:P
Last Name:KONEN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:ALICIA
Other - Middle Name:P
Other - Last Name:COLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:2222 SULLIVAN TRL
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18040-7958
Mailing Address - Country:US
Mailing Address - Phone:800-944-9782
Mailing Address - Fax:610-438-2024
Practice Address - Street 1:2030 CHARLIE HALL BLVD
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29414-5830
Practice Address - Country:US
Practice Address - Phone:843-763-4055
Practice Address - Fax:843-763-4056
Is Sole Proprietor?:No
Enumeration Date:2009-02-06
Last Update Date:2009-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2269225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist