Provider Demographics
NPI:1558989178
Name:CROCETTI, ALICIA MICHELLE (DPT)
Entity Type:Individual
Prefix:MRS
First Name:ALICIA
Middle Name:MICHELLE
Last Name:CROCETTI
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MISS
Other - First Name:ALICIA
Other - Middle Name:MICHELLE
Other - Last Name:CAMPBELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:201 PALOMA DR
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76502-2211
Mailing Address - Country:US
Mailing Address - Phone:254-892-0527
Mailing Address - Fax:
Practice Address - Street 1:201 PALOMA DR
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76502-2211
Practice Address - Country:US
Practice Address - Phone:254-892-0527
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-09
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019029996225100000X
TX1330699225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1330699OtherTEXAS BOARD OF PHYSICAL THERAPY EXAMINERS
MOT980350872OtherSTATE OF MISSOURI
MO2019029996OtherMISSOURI STATE BOARD OF HEALING ARTS