Provider Demographics
NPI:1508209461
Name:MARKS, ALICIA MAE (DPT)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:MAE
Last Name:MARKS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 ARLINGTON DR
Mailing Address - Street 2:
Mailing Address - City:SLIPPERY ROCK
Mailing Address - State:PA
Mailing Address - Zip Code:16057-1168
Mailing Address - Country:US
Mailing Address - Phone:814-242-7148
Mailing Address - Fax:
Practice Address - Street 1:138 ARLINGTON DR
Practice Address - Street 2:
Practice Address - City:SLIPPERY ROCK
Practice Address - State:PA
Practice Address - Zip Code:16057-1168
Practice Address - Country:US
Practice Address - Phone:814-242-7148
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-10
Last Update Date:2013-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT022133225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist