Provider Demographics
NPI:1831634716
Name:YODER, ALYSSA K (MS LAT ATC)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:K
Last Name:YODER
Suffix:
Gender:F
Credentials:MS LAT ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3431 DALE RD
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54703-0402
Mailing Address - Country:US
Mailing Address - Phone:715-450-2761
Mailing Address - Fax:
Practice Address - Street 1:3431 DALE RD
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54703-0402
Practice Address - Country:US
Practice Address - Phone:715-450-2761
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-30
Last Update Date:2016-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1600392255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer