Provider Demographics
NPI:1891725131
Name:RICHARDS, ALICIA MARIE (MSPT)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:MARIE
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:ALICIA
Other - Middle Name:
Other - Last Name:PODWIKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSPT
Mailing Address - Street 1:8 STRAWBERRY LN
Mailing Address - Street 2:
Mailing Address - City:DURYEA
Mailing Address - State:PA
Mailing Address - Zip Code:18642
Mailing Address - Country:US
Mailing Address - Phone:570-824-3444
Mailing Address - Fax:570-824-4021
Practice Address - Street 1:500 W. HOSPITAL STREET
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:PA
Practice Address - Zip Code:18517
Practice Address - Country:US
Practice Address - Phone:570-824-3444
Practice Address - Fax:570-824-4021
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2019-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT015224L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1113730OtherAETNA HMO
PA50053482OtherCAPITAL BLUE CROSS
PAP01762404OtherPA BLUE SHIELD
PA1113730OtherAETNA HMO