Provider Demographics
NPI:1427366533
Name:MYATT, ALYSSA R (ATC, VAT,L)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:R
Last Name:MYATT
Suffix:
Gender:F
Credentials:ATC, VAT,L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 SENTARA PARK
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464
Mailing Address - Country:US
Mailing Address - Phone:757-252-3050
Mailing Address - Fax:757-223-1062
Practice Address - Street 1:1300 SENTARA PARK
Practice Address - Street 2:3RD FLOOR
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23464
Practice Address - Country:US
Practice Address - Phone:757-252-3050
Practice Address - Fax:757-223-1062
Is Sole Proprietor?:No
Enumeration Date:2010-09-23
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01260015362255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer