Provider Demographics
NPI:1558078923
Name:BASS, ALDEN M (PT, DPT)
Entity Type:Individual
Prefix:MISS
First Name:ALDEN
Middle Name:M
Last Name:BASS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5108 NORTHWIND BLVD
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31605-7672
Mailing Address - Country:US
Mailing Address - Phone:229-244-1201
Mailing Address - Fax:
Practice Address - Street 1:5108 NORTHWIND BLVD
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31605-7672
Practice Address - Country:US
Practice Address - Phone:229-244-1201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-03
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT0163262251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic