Provider Demographics
NPI:1013289099
Name:CLIFFORD, ALICIA DURANTE (LPTA)
Entity Type:Individual
Prefix:MRS
First Name:ALICIA
Middle Name:DURANTE
Last Name:CLIFFORD
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:DURANTE
Other - Last Name:CLIFFORD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPTA
Mailing Address - Street 1:8106 RITTENHOUSE CIR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28270-1062
Mailing Address - Country:US
Mailing Address - Phone:704-995-0380
Mailing Address - Fax:
Practice Address - Street 1:10616 METROMONT PKWY
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-7656
Practice Address - Country:US
Practice Address - Phone:704-597-7228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-06
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1364225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant