Provider Demographics
NPI:1891103545
Name:LANCASTER, ALYSSA NICOLE (PT)
Entity Type:Individual
Prefix:MRS
First Name:ALYSSA
Middle Name:NICOLE
Last Name:LANCASTER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:ALYSSA
Other - Middle Name:
Other - Last Name:DAVIDSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1755 WITTINGTON PL
Mailing Address - Street 2:SUITE 175
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75234-1927
Mailing Address - Country:US
Mailing Address - Phone:866-221-5405
Mailing Address - Fax:
Practice Address - Street 1:700 W 13TH ST
Practice Address - Street 2:
Practice Address - City:HARPER
Practice Address - State:KS
Practice Address - Zip Code:67058-1401
Practice Address - Country:US
Practice Address - Phone:620-896-7324
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-25
Last Update Date:2014-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-04909225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist