Provider Demographics
NPI:1407017536
Name:CHRISTENSEN, ALYSA (PT)
Entity Type:Individual
Prefix:DR
First Name:ALYSA
Middle Name:
Last Name:CHRISTENSEN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:ALYSA
Other - Middle Name:
Other - Last Name:BEAGLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:4401 HARRISON BLVD
Mailing Address - Street 2:SUITE 2440
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-3195
Mailing Address - Country:US
Mailing Address - Phone:801-387-2775
Mailing Address - Fax:801-387-2780
Practice Address - Street 1:4401 HARRISON BLVD
Practice Address - Street 2:SUITE 2440
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-3195
Practice Address - Country:US
Practice Address - Phone:801-387-2775
Practice Address - Fax:801-387-2780
Is Sole Proprietor?:No
Enumeration Date:2008-06-20
Last Update Date:2016-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6962986-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000074135Medicare UPIN