Provider Demographics
NPI:1043628431
Name:RHODES, ALICIA HARVEY (ATC, LAT)
Entity type:Individual
Prefix:MRS
First Name:ALICIA
Middle Name:HARVEY
Last Name:RHODES
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:641 BLOSSOM HILL RD
Mailing Address - Street 2:
Mailing Address - City:LINCOLNTON
Mailing Address - State:NC
Mailing Address - Zip Code:28092-7365
Mailing Address - Country:US
Mailing Address - Phone:980-241-9103
Mailing Address - Fax:
Practice Address - Street 1:641 BLOSSOM HILL RD
Practice Address - Street 2:
Practice Address - City:LINCOLNTON
Practice Address - State:NC
Practice Address - Zip Code:28092-7365
Practice Address - Country:US
Practice Address - Phone:980-241-9103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-29
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC227442255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
070802462OtherBOC- CERTIFIED ATHLETIC TRAINER
NC22744OtherLICENSED ATHLETIC TRAINER