Provider Demographics
NPI:1790458107
Name:VENTURA, ALYSSA M (PT, DPT)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:M
Last Name:VENTURA
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 1:2400 WISTERIA DR STE A
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-2689
Mailing Address - Country:US
Mailing Address - Phone:770-982-0102
Mailing Address - Fax:770-982-0130
Practice Address - Street 1:2801 N DECATUR RD STE 230
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-7430
Practice Address - Country:US
Practice Address - Phone:404-294-7211
Practice Address - Fax:404-294-7595
Is Sole Proprietor?:No
Enumeration Date:2021-07-30
Last Update Date:2021-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP20452225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist