Provider Demographics
NPI:1881284909
Name:VICK, ALEA (DPT)
Entity type:Individual
Prefix:
First Name:ALEA
Middle Name:
Last Name:VICK
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 THREE RIVERS DR NE
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30161-4999
Mailing Address - Country:US
Mailing Address - Phone:706-292-0040
Mailing Address - Fax:706-528-9039
Practice Address - Street 1:305 N 5TH AVE SW
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-2837
Practice Address - Country:US
Practice Address - Phone:706-528-9053
Practice Address - Fax:706-528-9039
Is Sole Proprietor?:No
Enumeration Date:2021-01-22
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT015306225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist