Provider Demographics
NPI:1942255542
Name:ALKON, LIAT (PT)
Entity Type:Individual
Prefix:
First Name:LIAT
Middle Name:
Last Name:ALKON
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 1:7318 GENE AVE NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-1849
Mailing Address - Country:US
Mailing Address - Phone:505-881-4480
Mailing Address - Fax:
Practice Address - Street 1:2220 RAYMAC RD SW
Practice Address - Street 2:ALBUQUERQUE PUBLIC SCHOOL - PARK MIDDLE SCHOOL
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87105-6843
Practice Address - Country:US
Practice Address - Phone:505-296-9521
Practice Address - Fax:505-296-2200
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3120225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist