Provider Demographics
NPI:1710406517
Name:DEVOR, ALYSSA (PT, DPT)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:DEVOR
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1440 COUNTY ROAD 9
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:OH
Mailing Address - Zip Code:43420-9515
Mailing Address - Country:US
Mailing Address - Phone:419-618-3422
Mailing Address - Fax:
Practice Address - Street 1:182 SAINT FRANCIS AVE
Practice Address - Street 2:
Practice Address - City:TIFFIN
Practice Address - State:OH
Practice Address - Zip Code:44883-3456
Practice Address - Country:US
Practice Address - Phone:419-447-2723
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-12
Last Update Date:2019-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT017157225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist