Healthcare Provider Details

I. General information

NPI: 1841461076
Provider Name (Legal Business Name): ALICIA BETH HIRSCHT PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2008
Last Update Date: 10/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 GREENWICH OFFICE PARK 40 VALLEY DRIVE
GREENWICH CT
06831-5151
US

IV. Provider business mailing address

6 GREENWICH OFFICE PARK 40 VALLEY DRIVE
GREENWICH CT
06831-5151
US

V. Phone/Fax

Practice location:
  • Phone: 203-869-1145
  • Fax:
Mailing address:
  • Phone: 203-869-1145
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number8280
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number070013392
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: