Provider Demographics
NPI:1992976732
Name:BERTONI-HICKEY, ALICIA A (DPT)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:A
Last Name:BERTONI-HICKEY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:ALICIA
Other - Middle Name:A
Other - Last Name:BERTONI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7 GLEN RIDGE TER
Mailing Address - Street 2:
Mailing Address - City:NORWELL
Mailing Address - State:MA
Mailing Address - Zip Code:02061-1137
Mailing Address - Country:US
Mailing Address - Phone:781-718-8336
Mailing Address - Fax:
Practice Address - Street 1:7 GLEN RIDGE TER
Practice Address - Street 2:SUITE 304
Practice Address - City:NORWELL
Practice Address - State:MA
Practice Address - Zip Code:02061-1137
Practice Address - Country:US
Practice Address - Phone:781-718-8336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-20
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA18015225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist