Provider Demographics
NPI:1740597798
Name:CLOUSE, ALISSA D (DPT)
Entity Type:Individual
Prefix:
First Name:ALISSA
Middle Name:D
Last Name:CLOUSE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 COURT ST
Mailing Address - Street 2:STE 101
Mailing Address - City:WEST BRANCH
Mailing Address - State:MI
Mailing Address - Zip Code:48661-8767
Mailing Address - Country:US
Mailing Address - Phone:989-343-3000
Mailing Address - Fax:989-343-3003
Practice Address - Street 1:621 COURT ST
Practice Address - Street 2:STE 101
Practice Address - City:WEST BRANCH
Practice Address - State:MI
Practice Address - Zip Code:48661-8767
Practice Address - Country:US
Practice Address - Phone:989-343-3000
Practice Address - Fax:989-343-3003
Is Sole Proprietor?:No
Enumeration Date:2010-09-10
Last Update Date:2010-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501015336225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist