Provider Demographics
NPI:1558843185
Name:PHEASANT, ALYSSA (ATC)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:PHEASANT
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 ROBERT DANIEL DR APT 2217
Mailing Address - Street 2:
Mailing Address - City:DANIEL ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29492-7338
Mailing Address - Country:US
Mailing Address - Phone:814-505-8654
Mailing Address - Fax:
Practice Address - Street 1:515 ROBERT DANIEL DR APT 2217
Practice Address - Street 2:
Practice Address - City:DANIEL ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29492-7338
Practice Address - Country:US
Practice Address - Phone:814-505-8654
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-30
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCAT033412255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer