Healthcare Provider Details

I. General information

NPI: 1629645890
Provider Name (Legal Business Name): ALICIA A HOOD PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2021
Last Update Date: 06/07/2021
Certification Date: 06/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8902 N MERIDIAN ST STE 120
INDIANAPOLIS IN
46260-5306
US

IV. Provider business mailing address

8902 N MERIDIAN ST STE 120
INDIANAPOLIS IN
46260-5306
US

V. Phone/Fax

Practice location:
  • Phone: 317-581-1890
  • Fax:
Mailing address:
  • Phone: 317-581-1890
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number06006192A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: