Provider Demographics
NPI:1598817405
Name:FADDEN, ALICE CELIA (PT)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:CELIA
Last Name:FADDEN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5188 HEALTH CAMP RD
Mailing Address - Street 2:
Mailing Address - City:HOMER
Mailing Address - State:NY
Mailing Address - Zip Code:13077-8456
Mailing Address - Country:US
Mailing Address - Phone:607-749-3923
Mailing Address - Fax:
Practice Address - Street 1:FADDEN & ASSOCIATES PHYSICAL THERAPY, PLLC
Practice Address - Street 2:242 PORT WATSON STREET
Practice Address - City:CORTLAND
Practice Address - State:NY
Practice Address - Zip Code:13045
Practice Address - Country:US
Practice Address - Phone:607-758-7212
Practice Address - Fax:607-758-3416
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007216-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY4244901OtherAETNA US HEALTHCARE
NY4123842OtherMVP
NY4123842OtherMVP