Provider Demographics
NPI:1114384922
Name:VANPATTEN, ALYSSA (ATC)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:VANPATTEN
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 1:180 W CLARKE ST APT 12
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03104-2449
Mailing Address - Country:US
Mailing Address - Phone:518-956-1803
Mailing Address - Fax:603-222-4091
Practice Address - Street 1:180 W CLARKE ST APT 12
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03104-2449
Practice Address - Country:US
Practice Address - Phone:518-956-1803
Practice Address - Fax:603-222-4091
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-25
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2000006325204C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports Medicine