Provider Demographics
NPI:1740365725
Name:NIX, ALICE PFEIFFER (PT)
Entity type:Individual
Prefix:
First Name:ALICE
Middle Name:PFEIFFER
Last Name:NIX
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 1:3939 ROSWELL RD
Mailing Address - Street 2:SUITE 160
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-6251
Mailing Address - Country:US
Mailing Address - Phone:770-971-5244
Mailing Address - Fax:770-973-0586
Practice Address - Street 1:3939 ROSWELL RD
Practice Address - Street 2:SUITE 160
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-6251
Practice Address - Country:US
Practice Address - Phone:770-971-5244
Practice Address - Fax:770-973-0586
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA784225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA784OtherSTATE LICENSE #
GA00371874BMedicaid
GA784OtherSTATE LICENSE #
GA65BBBGHMedicare ID - Type Unspecified
GA65BBBGH01Medicare ID - Type Unspecified