Provider Demographics
NPI:1720212624
Name:PERDUE, ALICIA MARIE (PT)
Entity Type:Individual
Prefix:MS
First Name:ALICIA
Middle Name:MARIE
Last Name:PERDUE
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 1:90 MCLAIN ST
Mailing Address - Street 2:
Mailing Address - City:PATRICK
Mailing Address - State:SC
Mailing Address - Zip Code:29584-5264
Mailing Address - Country:US
Mailing Address - Phone:843-454-8474
Mailing Address - Fax:843-479-5855
Practice Address - Street 1:90 MCLAIN ST
Practice Address - Street 2:
Practice Address - City:PATRICK
Practice Address - State:SC
Practice Address - Zip Code:29584-5264
Practice Address - Country:US
Practice Address - Phone:843-454-8474
Practice Address - Fax:843-479-5855
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-06
Last Update Date:2009-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4139225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist