Provider Demographics
NPI:1477238178
Name:STOUT, ALYSSA ANN (ATC)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:ANN
Last Name:STOUT
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:ALYSSA
Other - Middle Name:ANN
Other - Last Name:CORBIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC
Mailing Address - Street 1:325 S 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:BROKEN BOW
Mailing Address - State:NE
Mailing Address - Zip Code:68822-2213
Mailing Address - Country:US
Mailing Address - Phone:308-872-5111
Mailing Address - Fax:308-872-5115
Practice Address - Street 1:325 S 1ST AVE
Practice Address - Street 2:
Practice Address - City:BROKEN BOW
Practice Address - State:NE
Practice Address - Zip Code:68822-2213
Practice Address - Country:US
Practice Address - Phone:308-872-5111
Practice Address - Fax:308-872-5115
Is Sole Proprietor?:No
Enumeration Date:2023-06-20
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH8572255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer