Provider Demographics
NPI:1669612529
Name:BAILEY, ALICIA MARIE (PTA)
Entity type:Individual
Prefix:MS
First Name:ALICIA
Middle Name:MARIE
Last Name:BAILEY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2623 DEER CROSSING ST
Mailing Address - Street 2:
Mailing Address - City:EL DORADO
Mailing Address - State:AR
Mailing Address - Zip Code:71730-6801
Mailing Address - Country:US
Mailing Address - Phone:870-862-8455
Mailing Address - Fax:870-864-9191
Practice Address - Street 1:431 W OAK ST
Practice Address - Street 2:
Practice Address - City:EL DORADO
Practice Address - State:AR
Practice Address - Zip Code:71730-4566
Practice Address - Country:US
Practice Address - Phone:870-864-9190
Practice Address - Fax:870-864-9191
Is Sole Proprietor?:No
Enumeration Date:2009-03-04
Last Update Date:2009-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2001225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant