Provider Demographics
NPI:1558675306
Name:PREWITT, ALYSIA LEE (PTA)
Entity Type:Individual
Prefix:MS
First Name:ALYSIA
Middle Name:LEE
Last Name:PREWITT
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1308 28TH ST
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-6002
Mailing Address - Country:US
Mailing Address - Phone:916-446-1497
Mailing Address - Fax:916-446-5959
Practice Address - Street 1:1308 28TH ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-6002
Practice Address - Country:US
Practice Address - Phone:916-446-1497
Practice Address - Fax:916-446-5959
Is Sole Proprietor?:No
Enumeration Date:2010-08-04
Last Update Date:2010-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAT 9292225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant