MEDICARE: MRS. ALICIA ELIZABETH VIGIL PTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	6579	TN

General Provider Information

NPI Number	:	1720891120
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ALICIA ELIZABETH VIGIL PTA

Provider Business Mailing Address
First Line	:	181 ETOWAH RD
Second Line	:
City	:	BENTON
State	:	TN
Zip	:	37307-3108
Country	:	US
Telephone Number	:	423-241-1148
Fax Number	:

Provider Business Practice Location Address
First Line	:	425 OLD RICEVILLE RD STE 1
Second Line	:
City	:	ATHENS
State	:	TN
Zip	:	37303-3072
Country	:	US
Telephone Number	:	423-744-0002
Fax Number	:	423-745-8727

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/29/2025
Last Update Date	:	01/29/2025

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Directions to “ MRS. ALICIA ELIZABETH VIGIL PTA” Practice Location

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