Provider Demographics
NPI:1578868915
Name:WAMUNGA, ALICE AKINYI (PT)
Entity Type:Individual
Prefix:MRS
First Name:ALICE
Middle Name:AKINYI
Last Name:WAMUNGA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:MILDRED
Other - Middle Name:
Other - Last Name:WASAMBLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:STUDENT
Mailing Address - Street 1:3200 TRUXEL RD APT 191
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95833-1059
Mailing Address - Country:US
Mailing Address - Phone:916-995-5908
Mailing Address - Fax:916-418-4250
Practice Address - Street 1:2315 STOCKTON BLVD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-2201
Practice Address - Country:US
Practice Address - Phone:916-734-7040
Practice Address - Fax:916-703-5191
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-16
Last Update Date:2011-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36224225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist