Provider Demographics
NPI:1376740035
Name:WHELAN, ALYSON (MSPT)
Entity Type:Individual
Prefix:
First Name:ALYSON
Middle Name:
Last Name:WHELAN
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:ALYSON
Other - Middle Name:
Other - Last Name:CAIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSPT
Mailing Address - Street 1:2408 WHITNEY AVE
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06518-3209
Mailing Address - Country:US
Mailing Address - Phone:203-626-0160
Mailing Address - Fax:203-848-2367
Practice Address - Street 1:12 BOKUM RD
Practice Address - Street 2:
Practice Address - City:ESSEX
Practice Address - State:CT
Practice Address - Zip Code:06426-1500
Practice Address - Country:US
Practice Address - Phone:860-767-9053
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT008119225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT080008119CT01OtherBLUE CROSS BLUE SHIELD
CTCG5311OtherRAILROAD MEDICARE
CT080008119CT02OtherBLUE SHIELD
CT650001459Medicare PIN