Provider Demographics
NPI:1730235664
Name:FOX, ALICE ROBERTSON (MS, PT)
Entity type:Individual
Prefix:
First Name:ALICE
Middle Name:ROBERTSON
Last Name:FOX
Suffix:
Gender:F
Credentials:MS, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2842 HIGHWAY 30
Mailing Address - Street 2:
Mailing Address - City:COLUMBIANA
Mailing Address - State:AL
Mailing Address - Zip Code:35051-5057
Mailing Address - Country:US
Mailing Address - Phone:205-669-9172
Mailing Address - Fax:
Practice Address - Street 1:2842 HIGHWAY 30
Practice Address - Street 2:
Practice Address - City:COLUMBIANA
Practice Address - State:AL
Practice Address - Zip Code:35051-5057
Practice Address - Country:US
Practice Address - Phone:205-790-0264
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL21729225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist