Provider Demographics
NPI:1578932455
Name:WU, ALYSSA
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:WU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1230
Mailing Address - Street 2:
Mailing Address - City:PALMER
Mailing Address - State:AK
Mailing Address - Zip Code:99645-1230
Mailing Address - Country:US
Mailing Address - Phone:907-274-0627
Mailing Address - Fax:
Practice Address - Street 1:825 N LUCUS RD
Practice Address - Street 2:STE E
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-6268
Practice Address - Country:US
Practice Address - Phone:907-274-0627
Practice Address - Fax:833-318-1416
Is Sole Proprietor?:No
Enumeration Date:2015-09-21
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK104731225100000X
ID4149225100000X
NY039488225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist