Provider Demographics
NPI:1437910601
Name:HARVEY, BAJA ALICIA (LMT)
Entity Type:Individual
Prefix:
First Name:BAJA
Middle Name:ALICIA
Last Name:HARVEY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 W MADISON ST
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31021-5175
Mailing Address - Country:US
Mailing Address - Phone:478-304-0004
Mailing Address - Fax:
Practice Address - Street 1:126 W MADISON ST
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31021-5175
Practice Address - Country:US
Practice Address - Phone:478-303-0004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-16
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT014362225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist