Provider Demographics
NPI:1629839857
Name:MINICH, ALYSSA (MT-BC)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:MINICH
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 VALE DR
Mailing Address - Street 2:
Mailing Address - City:BOYERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19512-8101
Mailing Address - Country:US
Mailing Address - Phone:610-781-5190
Mailing Address - Fax:
Practice Address - Street 1:62 VALE DR
Practice Address - Street 2:
Practice Address - City:BOYERTOWN
Practice Address - State:PA
Practice Address - Zip Code:19512-8101
Practice Address - Country:US
Practice Address - Phone:610-781-5190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-16
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA18472225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist