Provider Demographics
NPI:1912224742
Name:HEADING, ALICIA MICHELLE (DPT)
Entity Type:Individual
Prefix:MRS
First Name:ALICIA
Middle Name:MICHELLE
Last Name:HEADING
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MS
Other - First Name:ALICIA
Other - Middle Name:MICHELLE
Other - Last Name:KONTRY/FLACHS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:2524 W WACKERLY ST
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-6921
Mailing Address - Country:US
Mailing Address - Phone:989-423-1240
Mailing Address - Fax:989-423-1243
Practice Address - Street 1:2524 W WACKERLY ST
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-6921
Practice Address - Country:US
Practice Address - Phone:989-423-1240
Practice Address - Fax:989-423-1243
Is Sole Proprietor?:No
Enumeration Date:2010-05-04
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501013365225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist