Provider Demographics
NPI:1407679533
Name:MAIO, ALECIA MARIE
Entity type:Individual
Prefix:
First Name:ALECIA
Middle Name:MARIE
Last Name:MAIO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 RIVERBEND RD
Mailing Address - Street 2:
Mailing Address - City:WELLS
Mailing Address - State:ME
Mailing Address - Zip Code:04090-4740
Mailing Address - Country:US
Mailing Address - Phone:603-828-4799
Mailing Address - Fax:
Practice Address - Street 1:25919 GADING RD
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94544-2725
Practice Address - Country:US
Practice Address - Phone:510-782-8424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-06
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53558225200000X
MEPA6017225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant