Healthcare Provider Details

I. General information

NPI: 1609705029
Provider Name (Legal Business Name): ALICIA A HAMPTON PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2026
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 JEAN ST
YALE MI
48097-2932
US

IV. Provider business mailing address

5584 KELLY RD
MUSSEY MI
48014-1513
US

V. Phone/Fax

Practice location:
  • Phone: 810-387-3226
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number5502003902
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: