MEDICARE: MS. ALICIA LAUREN KINSEY P.T.

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	225100000X	Physical Therapist	P13858	NC

General Provider Information

NPI Number	:	1821345083
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ALICIA LAUREN KINSEY P.T.

Provider Business Mailing Address
First Line	:	1317 N BRIGHTLEAF BLVD STE A
Second Line	:
City	:	SMITHFIELD
State	:	NC
Zip	:	27577-7267
Country	:	US
Telephone Number	:	919-300-5040
Fax Number	:	919-438-0893

Provider Business Practice Location Address
First Line	:	1317 N BRIGHTLEAF BLVD STE A
Second Line	:
City	:	SMITHFIELD
State	:	NC
Zip	:	27577-7267
Country	:	US
Telephone Number	:	919-300-5040
Fax Number	:	919-438-0893

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

Provider Enumeration Date	:	08/07/2012
Last Update Date	:	08/07/2012

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