Provider Demographics
NPI:1043541311
Name:NAMM, ALISSA LYNN (DPT)
Entity Type:Individual
Prefix:MRS
First Name:ALISSA
Middle Name:LYNN
Last Name:NAMM
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1044 HARDING ST
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07090-1218
Mailing Address - Country:US
Mailing Address - Phone:973-420-5148
Mailing Address - Fax:
Practice Address - Street 1:29 ALDEN ST STE 1A
Practice Address - Street 2:
Practice Address - City:CRANFORD
Practice Address - State:NJ
Practice Address - Zip Code:07016-2156
Practice Address - Country:US
Practice Address - Phone:646-841-1414
Practice Address - Fax:212-379-2122
Is Sole Proprietor?:No
Enumeration Date:2010-01-26
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032102174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist