Provider Demographics
NPI:1194898940
Name:LOCICERO, AMIE ALAGOOD (PT)
Entity type:Individual
Prefix:MRS
First Name:AMIE
Middle Name:ALAGOOD
Last Name:LOCICERO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
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Mailing Address - Street 1:4727 ARDMORE LN
Mailing Address - Street 2:
Mailing Address - City:HOSCHTON
Mailing Address - State:GA
Mailing Address - Zip Code:30548-6228
Mailing Address - Country:US
Mailing Address - Phone:770-307-5909
Mailing Address - Fax:678-377-2882
Practice Address - Street 1:545 OLD NORCROSS RD
Practice Address - Street 2:SUITE 100
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-3389
Practice Address - Country:US
Practice Address - Phone:678-377-2833
Practice Address - Fax:678-377-2882
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA004192225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist