Provider Demographics
NPI:1104355668
Name:ENGER, ALYSSA (ATC)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:ENGER
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2258 N MORELLO AVE
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-4146
Mailing Address - Country:US
Mailing Address - Phone:208-407-9324
Mailing Address - Fax:
Practice Address - Street 1:2258 N MORELLO AVE
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83646-4146
Practice Address - Country:US
Practice Address - Phone:208-407-9324
Practice Address - Fax:208-407-9324
Is Sole Proprietor?:No
Enumeration Date:2017-06-08
Last Update Date:2017-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer