Provider Demographics
NPI:1437292075
Name:KORT, ALICIA MORIAH (MS ED)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:MORIAH
Last Name:KORT
Suffix:
Gender:F
Credentials:MS ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28662 LA AZTECA
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-7646
Mailing Address - Country:US
Mailing Address - Phone:949-413-2520
Mailing Address - Fax:
Practice Address - Street 1:1310 W STEWART DR
Practice Address - Street 2:510
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3854
Practice Address - Country:US
Practice Address - Phone:714-538-8549
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer