Provider Demographics
NPI:1962465328
Name:THOMAS, ALICIA F (ATC)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:F
Last Name:THOMAS
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:716 E SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:IN
Mailing Address - Zip Code:47670-1758
Mailing Address - Country:US
Mailing Address - Phone:812-887-7733
Mailing Address - Fax:
Practice Address - Street 1:702 OLD WHEATLAND RD
Practice Address - Street 2:
Practice Address - City:VINCENNES
Practice Address - State:IN
Practice Address - Zip Code:47591-3620
Practice Address - Country:US
Practice Address - Phone:812-882-1141
Practice Address - Fax:812-886-6333
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN36000768A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer