Provider Demographics
NPI:1417421702
Name:HAJDU, ALICE (PT)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:
Last Name:HAJDU
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 1:523 FAIR HILL DR
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96003-5219
Mailing Address - Country:US
Mailing Address - Phone:805-308-2556
Mailing Address - Fax:
Practice Address - Street 1:2449 COURT ST
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-2525
Practice Address - Country:US
Practice Address - Phone:530-244-7686
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-19
Last Update Date:2019-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT294316225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist