Provider Demographics
NPI:1013222033
Name:OKUN, ALYSSA RENEE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:RENEE
Last Name:OKUN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:189 PARKER ST
Mailing Address - Street 2:
Mailing Address - City:MAYNARD
Mailing Address - State:MA
Mailing Address - Zip Code:01754-2133
Mailing Address - Country:US
Mailing Address - Phone:617-308-0713
Mailing Address - Fax:
Practice Address - Street 1:189 PARKER ST
Practice Address - Street 2:
Practice Address - City:MAYNARD
Practice Address - State:MA
Practice Address - Zip Code:01754-2133
Practice Address - Country:US
Practice Address - Phone:617-308-0713
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-13
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA18572225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist