Provider Demographics
NPI:1063856714
Name:FRICK, ALYSSA (CPTA)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:FRICK
Suffix:
Gender:F
Credentials:CPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2707 VINE ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:HAYS
Mailing Address - State:KS
Mailing Address - Zip Code:67601-1949
Mailing Address - Country:US
Mailing Address - Phone:785-628-2105
Mailing Address - Fax:
Practice Address - Street 1:2707 VINE ST
Practice Address - Street 2:SUITE 1
Practice Address - City:HAYS
Practice Address - State:KS
Practice Address - Zip Code:67601-1949
Practice Address - Country:US
Practice Address - Phone:785-628-2105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-24
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14-02184225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant