Provider Demographics
NPI:1396204996
Name:WRAGE, ALYSSA MARY
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:MARY
Last Name:WRAGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2215 R AVE
Mailing Address - Street 2:
Mailing Address - City:CLUTIER
Mailing Address - State:IA
Mailing Address - Zip Code:52217-9533
Mailing Address - Country:US
Mailing Address - Phone:319-930-2100
Mailing Address - Fax:
Practice Address - Street 1:2215 R AVE
Practice Address - Street 2:
Practice Address - City:CLUTIER
Practice Address - State:IA
Practice Address - Zip Code:52217-9533
Practice Address - Country:US
Practice Address - Phone:319-930-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-14
Last Update Date:2019-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer