Provider Demographics
NPI:1639493695
Name:HEILI, ALICIA ELIZABETH (MS, ATC)
Entity Type:Individual
Prefix:MISS
First Name:ALICIA
Middle Name:ELIZABETH
Last Name:HEILI
Suffix:
Gender:F
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 CUMMINGS DR
Mailing Address - Street 2:APT 404
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22554-7174
Mailing Address - Country:US
Mailing Address - Phone:785-331-7733
Mailing Address - Fax:
Practice Address - Street 1:24164 BELLEAU
Practice Address - Street 2:
Practice Address - City:QUANTICO
Practice Address - State:VA
Practice Address - Zip Code:22134
Practice Address - Country:US
Practice Address - Phone:703-784-6558
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-19
Last Update Date:2010-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01260012382255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer