Provider Demographics
NPI:1407391238
Name:CARRILLO, ALYSSA ALEXANDRA (PT, DPT)
Entity Type:Individual
Prefix:MS
First Name:ALYSSA
Middle Name:ALEXANDRA
Last Name:CARRILLO
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 S TYLER ST
Mailing Address - Street 2:SUITE 805
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79101-2353
Mailing Address - Country:US
Mailing Address - Phone:806-553-7780
Mailing Address - Fax:806-553-7771
Practice Address - Street 1:600 S TYLER ST
Practice Address - Street 2:SUITE 805
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79101-2353
Practice Address - Country:US
Practice Address - Phone:806-553-7780
Practice Address - Fax:806-553-7771
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-03
Last Update Date:2017-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1281479225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist