Provider Demographics
NPI:1720891120
Name:VIGIL, ALICIA ELIZABETH (PTA)
Entity type:Individual
Prefix:MRS
First Name:ALICIA
Middle Name:ELIZABETH
Last Name:VIGIL
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MS
Other - First Name:ALICIA
Other - Middle Name:ELIZABETH
Other - Last Name:KING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:181 ETOWAH RD
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:TN
Mailing Address - Zip Code:37307-3108
Mailing Address - Country:US
Mailing Address - Phone:423-241-1148
Mailing Address - Fax:
Practice Address - Street 1:425 OLD RICEVILLE RD STE 1
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:TN
Practice Address - Zip Code:37303-3072
Practice Address - Country:US
Practice Address - Phone:423-744-0002
Practice Address - Fax:423-745-8727
Is Sole Proprietor?:No
Enumeration Date:2025-01-29
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6579225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant