Provider Demographics
NPI:1598651739
Name:HAGAN, ALICIA ANNETTE (DPT)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:ANNETTE
Last Name:HAGAN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:ALICIA
Other - Middle Name:ANNETTE
Other - Last Name:PACE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPT
Mailing Address - Street 1:34 HIGGINS CUTOFF RD
Mailing Address - Street 2:
Mailing Address - City:SUMRALL
Mailing Address - State:MS
Mailing Address - Zip Code:39482-9596
Mailing Address - Country:US
Mailing Address - Phone:601-408-3002
Mailing Address - Fax:
Practice Address - Street 1:418 SUMRALL RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MS
Practice Address - Zip Code:39429-9572
Practice Address - Country:US
Practice Address - Phone:601-736-8431
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-16
Last Update Date:2025-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS7565225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist