Provider Demographics
NPI:1548218357
Name:GRAM, ALISSA ANNE (PT)
Entity Type:Individual
Prefix:
First Name:ALISSA
Middle Name:ANNE
Last Name:GRAM
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:ALISSA
Other - Middle Name:ANNE
Other - Last Name:PLUFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:7723 CENTER BLVD SE
Mailing Address - Street 2:
Mailing Address - City:SNOQUALMIE
Mailing Address - State:WA
Mailing Address - Zip Code:98065-8930
Mailing Address - Country:US
Mailing Address - Phone:425-396-7778
Mailing Address - Fax:425-396-7097
Practice Address - Street 1:7723 CENTER BLVD SE
Practice Address - Street 2:
Practice Address - City:SNOQUALMIE
Practice Address - State:WA
Practice Address - Zip Code:98065-8930
Practice Address - Country:US
Practice Address - Phone:425-396-7778
Practice Address - Fax:425-396-7097
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00009251225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8857498Medicare ID - Type Unspecified