Provider Demographics
NPI:1275152779
Name:TEMPLAIN, ALYSSA (PTA)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:TEMPLAIN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8715 W HIGHWAY 71 APT 2105
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78735-0033
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5400 BRODIE LN STE 295
Practice Address - Street 2:
Practice Address - City:SUNSET VALLEY
Practice Address - State:TX
Practice Address - Zip Code:78745-2525
Practice Address - Country:US
Practice Address - Phone:512-676-3949
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-14
Last Update Date:2020-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2096552225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant