Provider Demographics
NPI:1346783693
Name:FAETH, ALYSSA REITER (DPT, PT)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:REITER
Last Name:FAETH
Suffix:
Gender:F
Credentials:DPT, PT
Other - Prefix:
Other - First Name:ALYSSA
Other - Middle Name:ELIZABETH
Other - Last Name:REITER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT, PT
Mailing Address - Street 1:5672 CORINTH DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80923
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2818 GRAND VISTA CIR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80904-5242
Practice Address - Country:US
Practice Address - Phone:719-632-7000
Practice Address - Fax:719-632-4000
Is Sole Proprietor?:No
Enumeration Date:2016-11-18
Last Update Date:2016-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.0013579225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist