Alicia Bolden, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

24149 Issued in MD

Practice address

4 Park Center Court
Suite 102
Owings Mills, MD 21117

Phone

(410) 377-8900

Fax

(410) 377-3512

NPI assigned

Jan 23, 2014

Last updated

Jan 23, 2014By 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

Medicare fee-for-service enrollment

Enrolled in MD

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2011

Medicare assignment

May accept Medicare assignment

Group practices

Origin Physical Therapy FL PLLCGroup PAC ID 1759813348, 77 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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.

• Origin Physical Therapy FL PLLC

  • Physical Therapist
  • Austin, TX
  • NPI 1477220861

  MD

  Medicare reassignment Care Compare group NPD
• To the Core Physical Therapy & Conditioning, LLC

  • Physical Therapist
  • Towson, MD
  • NPI 1538583646
  NPD
• Orthopaedic Specialty Center

  • Orthopaedic Surgery Physician
  • Towson, MD
  • NPI 1518090851
  NPD (past)

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

{
    "created_epoch": "1390435200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1390435200000",
    "number": "1700209947",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2700 QUARRY LAKE DRIVE",
            "address_2": "SUITE 300",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "21209",
            "telephone_number": "410-377-8900",
            "fax_number": "410-377-3512"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4 PARK CENTER COURT",
            "address_2": "SUITE 102",
            "city": "OWINGS MILLS",
            "state": "MD",
            "postal_code": "21117",
            "telephone_number": "410-377-8900",
            "fax_number": "410-377-3512"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOLDEN",
        "first_name": "ALICIA",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-01-23",
        "last_updated": "2014-01-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MD",
            "license": "24149",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Blue Balloon MD LLC
• Blue Balloon MD LLC
• David Body, D.M.D.
• Nevin Body, D.O.
• Bodyfit Wellness LLC
• Destynee Bolton
• Melissa Bonbrest
• Alyssa Bond
• Julia Marie Bonner
• Winifred J Booker, DDS

• Physical Therapist in Owings Mills, MD
• Providers in Owings Mills, MD by specialty
• Physical Therapist in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.