Provider Demographics
NPI:1962855577
Name:LEE, ALYSSA RAE (ATC)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:RAE
Last Name:LEE
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:ALYSSA
Other - Middle Name:RAE
Other - Last Name:LENIUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC
Mailing Address - Street 1:5660 GORDON RD
Mailing Address - Street 2:
Mailing Address - City:STURGEON BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54235-8839
Mailing Address - Country:US
Mailing Address - Phone:920-216-1844
Mailing Address - Fax:
Practice Address - Street 1:323 S 18TH AVE
Practice Address - Street 2:
Practice Address - City:STURGEON BAY
Practice Address - State:WI
Practice Address - Zip Code:54235-1401
Practice Address - Country:US
Practice Address - Phone:920-743-5566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-19
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1545-0392255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer