Provider Demographics
NPI:1942647375
Name:ROOT, ALYSSA A (PT)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:A
Last Name:ROOT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3307 GRAND AVE
Mailing Address - Street 2:STE 203
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-6546
Mailing Address - Country:US
Mailing Address - Phone:406-655-9060
Mailing Address - Fax:406-655-9065
Practice Address - Street 1:1015 OCEAN BEACH HWY STE 16
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-4098
Practice Address - Country:US
Practice Address - Phone:360-501-3750
Practice Address - Fax:360-501-3755
Is Sole Proprietor?:No
Enumeration Date:2013-05-24
Last Update Date:2020-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
WAPT60954901225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist