Provider Demographics
NPI:1790830875
Name:RABENA-AMEN, ALICIA KRISTEN (PT)
Entity Type:Individual
Prefix:MS
First Name:ALICIA
Middle Name:KRISTEN
Last Name:RABENA-AMEN
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 1:5058 TUDOR ROSE GLEN
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95212-9239
Mailing Address - Country:US
Mailing Address - Phone:209-931-1485
Mailing Address - Fax:
Practice Address - Street 1:8600 BRUICEVILLE DRIVE
Practice Address - Street 2:PHYSICAL THERAPY DEPARTMENT
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823
Practice Address - Country:US
Practice Address - Phone:916-688-2211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT23049225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist