Provider Demographics
NPI:1619369261
Name:ADDISON, ALYSON NICOLE (PT, DPT, CLT)
Entity Type:Individual
Prefix:
First Name:ALYSON
Middle Name:NICOLE
Last Name:ADDISON
Suffix:
Gender:F
Credentials:PT, DPT, CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 GRANDEVILLE RD SW
Mailing Address - Street 2:UNIT 1511
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55902-3572
Mailing Address - Country:US
Mailing Address - Phone:630-302-2597
Mailing Address - Fax:
Practice Address - Street 1:62 GRANDEVILLE RD SW
Practice Address - Street 2:UNIT 1511
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55902-3572
Practice Address - Country:US
Practice Address - Phone:630-302-2597
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-19
Last Update Date:2015-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8689225100000X
IL070.021249225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist