Provider Demographics
NPI:1922407899
Name:LUND, ALYSSA
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:LUND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 4TH ST
Mailing Address - Street 2:
Mailing Address - City:GARRETSON
Mailing Address - State:SD
Mailing Address - Zip Code:57030-2006
Mailing Address - Country:US
Mailing Address - Phone:605-594-3466
Mailing Address - Fax:605-594-6662
Practice Address - Street 1:920 4TH ST
Practice Address - Street 2:
Practice Address - City:GARRETSON
Practice Address - State:SD
Practice Address - Zip Code:57030-2006
Practice Address - Country:US
Practice Address - Phone:605-594-3466
Practice Address - Fax:605-594-6662
Is Sole Proprietor?:No
Enumeration Date:2014-08-17
Last Update Date:2014-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0402225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant