Healthcare Provider Details

I. General information

NPI: 1407679533
Provider Name (Legal Business Name): ALECIA MARIE MAIO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2024
Last Update Date: 11/06/2024
Certification Date: 11/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25919 GADING RD
HAYWARD CA
94544-2725
US

IV. Provider business mailing address

62 RIVERBEND RD
WELLS ME
04090-4740
US

V. Phone/Fax

Practice location:
  • Phone: 510-782-8424
  • Fax:
Mailing address:
  • Phone: 603-828-4799
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number53558
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPA6017
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: