Individual
ALISIA KAYE MACIOCH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.S., LAT, ATC
Contact information
Practice address
1240 COUNTY ROAD B2 W, ROSEVILLE, MN 55113-4338
(651) 301-2279
Mailing address
320 6TH AVE S, SOUTH SAINT PAUL, MN 55075-2624
Taxonomy
Speciality
Code
Description
License number
State
2081S0010X
Sports Medicine (Physical Medicine & Rehabilitation) Physician
Primary
3138
MN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/11/2017
Last updated
03/05/2026
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