Alicia L. Clark, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT018773 Issued in PA

Practice address

4805 Birney Ave
Moosic, PA 18507-1231

Phone

(570) 774-4200

NPI assigned

Apr 27, 2012

Last updated

Oct 9, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Alicia Delazio Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Elite Spine and Sports Physical Therapy LP

  • Physical Therapist
  • Wilkes Barre, PA
  • NPI 1932810819
  NPD
• Elite Spine and Sports Physical Therapy

  • Physical Therapist
  • Wilkes Barre, PA
  • NPI 1134468598
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1335484800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1696809600000",
    "number": "1265790240",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4805 BIRNEY AVE",
            "city": "MOOSIC",
            "state": "PA",
            "postal_code": "185071231",
            "telephone_number": "570-774-4200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4805 BIRNEY AVE",
            "city": "MOOSIC",
            "state": "PA",
            "postal_code": "185071231",
            "telephone_number": "570-774-4200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "ALICIA",
        "middle_name": "L.",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-04-27",
        "last_updated": "2023-10-09",
        "certification_date": "2023-10-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "PA",
            "license": "PT018773",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ALICIA",
            "last_name": "DELAZIO",
            "credential": "DPT",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Danielle Burge, LPC
• Ethan Calafut
• Mary E. Callahan, RN MSM CRNP
• CD Glenmaura LLC
• Stacy Lynn Cella, PHARMD
• Teresa M Clark, CRNP
• Coh Mental Health Wellness LLC (Coh Mental Health Wellness)
• Coleman Counseling and Wellness LLC Dba Coleman Ocd & Anxiety Therapy
• Chelsea Taylor Collins, LSW
• Comprehensive Care Clinic

• Physical Therapist in Moosic, PA
• Providers in Moosic, PA by specialty
• Physical Therapist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.