Provider Demographics
NPI:1194373803
Name:KIEVIT, ALYSSA (PT, DPT)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:KIEVIT
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:ALYSSA
Other - Middle Name:
Other - Last Name:RAMOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:15 GODWIN AVE
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-3739
Mailing Address - Country:US
Mailing Address - Phone:201-497-0117
Mailing Address - Fax:
Practice Address - Street 1:15 GODWIN AVE
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-3739
Practice Address - Country:US
Practice Address - Phone:201-497-0117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-27
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
NJ40QA01880500225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist