Individual
ALICIA MARIE SHOUP
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
10165 E HAMPTON AVE, MESA, AZ 85209-3327
(480) 354-5424
Mailing address
10165 E HAMPTON AVE, MESA, AZ 85209-3327
(480) 354-5424
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
DAPT000189
PA
2251X0800X
Orthopedic Physical Therapist
Primary
11544PT
AZ
2251X0800X
Orthopedic Physical Therapist
PT007130L
PA
Other
Enumeration date
07/02/2015
Last updated
07/02/2015
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