Provider Demographics
NPI:1811886104
Name:BRAVO, ALICIA MARGARET (PTA)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:MARGARET
Last Name:BRAVO
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4098 ENCLAVE DR
Mailing Address - Street 2:
Mailing Address - City:TURLOCK
Mailing Address - State:CA
Mailing Address - Zip Code:95382-7419
Mailing Address - Country:US
Mailing Address - Phone:209-814-9104
Mailing Address - Fax:
Practice Address - Street 1:2125 N OLIVE AVE
Practice Address - Street 2:
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95382-1960
Practice Address - Country:US
Practice Address - Phone:209-585-3805
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-01
Last Update Date:2025-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5773225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant