Provider Demographics
NPI:1710444104
Name:MAUCH, ALISIA
Entity Type:Individual
Prefix:
First Name:ALISIA
Middle Name:
Last Name:MAUCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ALISIA
Other - Middle Name:
Other - Last Name:RIVERA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11505 DECATUR PLZ APT 4112
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-4644
Mailing Address - Country:US
Mailing Address - Phone:308-850-5415
Mailing Address - Fax:
Practice Address - Street 1:2305 S 10TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68108-1108
Practice Address - Country:US
Practice Address - Phone:402-345-5683
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-21
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3876225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist