Provider Demographics
NPI:1851873095
Name:AMUNDSON, ALYSSA MARIE (PT)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:MARIE
Last Name:AMUNDSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:ALYSSA
Other - Middle Name:MARIE
Other - Last Name:WILLIAMSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:3205 NE 8TH ST
Mailing Address - Street 2:
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50021-9211
Mailing Address - Country:US
Mailing Address - Phone:515-577-7983
Mailing Address - Fax:
Practice Address - Street 1:24 8TH ST NW
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55901-6817
Practice Address - Country:US
Practice Address - Phone:507-424-4027
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-04
Last Update Date:2020-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN11316225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist