Provider Demographics
NPI:1205216926
Name:YENSER, ALISSA RAYANN (MS, LAT, ATC)
Entity Type:Individual
Prefix:
First Name:ALISSA
Middle Name:RAYANN
Last Name:YENSER
Suffix:
Gender:F
Credentials:MS, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2217 FAIRVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19606-1823
Mailing Address - Country:US
Mailing Address - Phone:484-336-4996
Mailing Address - Fax:
Practice Address - Street 1:1350 BROADCASTING RD STE 201
Practice Address - Street 2:
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-3229
Practice Address - Country:US
Practice Address - Phone:484-336-4996
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-08
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0061942255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2000020559OtherBOARD OF CERTIFICATION