Healthcare Provider Details

I. General information

NPI: 1639642101
Provider Name (Legal Business Name): ALICIA MARIE HARRINGTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALICIA MARIE RAYA

II. Dates (important events)

Enumeration Date: 01/08/2019
Last Update Date: 08/19/2020
Certification Date: 08/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 COHO ST STE 100
MADISON WI
53713-4576
US

IV. Provider business mailing address

2801 COHO ST STE 100
MADISON WI
53713-4576
US

V. Phone/Fax

Practice location:
  • Phone: 608-273-4434
  • Fax:
Mailing address:
  • Phone: 608-273-4434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: