Healthcare Provider Details

I. General information

NPI: 1114222593
Provider Name (Legal Business Name): ALICIA SHANNON FRANK LPTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ALICIA SHANNON RILEY LPTA

II. Dates (important events)

Enumeration Date: 01/17/2011
Last Update Date: 01/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 MESA DR
PLAINVIEW TX
79072-3905
US

IV. Provider business mailing address

PO BOX 93
ANDALUSIA AL
36420-1201
US

V. Phone/Fax

Practice location:
  • Phone: 334-208-1131
  • Fax:
Mailing address:
  • Phone: 334-208-1131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number5563
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2079810
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: