Provider Demographics
NPI:1134380884
Name:LONG, ALICE LURLINE (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:
First Name:ALICE
Middle Name:LURLINE
Last Name:LONG
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:859 HACIENDA WAY
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-2911
Mailing Address - Country:US
Mailing Address - Phone:415-507-0377
Mailing Address - Fax:415-491-1320
Practice Address - Street 1:1550 SILVEIRA PKWY
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903-4879
Practice Address - Country:US
Practice Address - Phone:415-446-3817
Practice Address - Fax:415-491-1320
Is Sole Proprietor?:No
Enumeration Date:2008-06-24
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA111802251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics