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NPI Code Detail

MEDICARE: ALICIA WALES PT, DPT

MEDICARE:   ALICIA  WALES  PT, DPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist11575MN

General Provider Information

NPI Number : 1134773336
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALICIA WALES PT, DPT
Provider Business Mailing Address
First Line : 1301 50TH ST E
Second Line :
City : INVER GROVE HEIGHTS
State : MN
Zip : 55077-1250
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1301 50TH ST E
Second Line :
City : INVER GROVE HEIGHTS
State : MN
Zip : 55077-1250
Country : US
Telephone Number : 651-451-1853
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/26/2019
Last Update Date : 07/26/2019

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Directions to “ ALICIA WALES PT, DPT” Practice Location

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