Provider Demographics
NPI:1104198431
Name:WIDGER, ALYSE ANN (DPT)
Entity Type:Individual
Prefix:
First Name:ALYSE
Middle Name:ANN
Last Name:WIDGER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:ALYSE
Other - Middle Name:ANN
Other - Last Name:PARKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:1257 CARMONT DR
Mailing Address - Street 2:
Mailing Address - City:MEADVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16335-2822
Mailing Address - Country:US
Mailing Address - Phone:814-671-8353
Mailing Address - Fax:
Practice Address - Street 1:455 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:MEADVILLE
Practice Address - State:PA
Practice Address - Zip Code:16335-4404
Practice Address - Country:US
Practice Address - Phone:814-547-6510
Practice Address - Fax:814-547-6511
Is Sole Proprietor?:No
Enumeration Date:2012-02-02
Last Update Date:2016-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT26514225100000X
PAPT024250225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist