Provider Demographics
NPI:1215263033
Name:RIALS, ALICIA ANN (DPT)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:ANN
Last Name:RIALS
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 1:6077 HIGHWAY 18
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:MS
Mailing Address - Zip Code:39175-9341
Mailing Address - Country:US
Mailing Address - Phone:913-626-5821
Mailing Address - Fax:
Practice Address - Street 1:6077 HIGHWAY 18
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:MS
Practice Address - Zip Code:39175-9341
Practice Address - Country:US
Practice Address - Phone:913-626-5821
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-29
Last Update Date:2013-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA07970R225100000X
MSPT4815225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist