Provider Demographics
NPI:1013367689
Name:DODD, ALYSSA CHRISTINE (MS, LAT, ATC, OTC)
Entity Type:Individual
Prefix:MRS
First Name:ALYSSA
Middle Name:CHRISTINE
Last Name:DODD
Suffix:
Gender:F
Credentials:MS, LAT, ATC, OTC
Other - Prefix:MS
Other - First Name:ALYSSA
Other - Middle Name:CHRISTINE
Other - Last Name:MONAHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15813 PAUL VEGA MD DR STE 100
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70403-1431
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15813 PAUL VEGA MD DR STE 100
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-1431
Practice Address - Country:US
Practice Address - Phone:985-230-2663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-15
Last Update Date:2023-02-16
Deactivation Date:2019-11-19
Deactivation Code:
Reactivation Date:2022-10-04
Provider Licenses
StateLicense IDTaxonomies
22-1108246ZX2200X
LA3122042255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No246ZX2200XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherOrthopedic Assistant