Provider Demographics
NPI:1972028348
Name:GRAESSER, ALISYN VICTORIA (DPT)
Entity Type:Individual
Prefix:
First Name:ALISYN
Middle Name:VICTORIA
Last Name:GRAESSER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2210 W TREVI PL APT 365
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-7520
Mailing Address - Country:US
Mailing Address - Phone:605-830-1570
Mailing Address - Fax:
Practice Address - Street 1:909 N IOWA AVE
Practice Address - Street 2:
Practice Address - City:DELL RAPIDS
Practice Address - State:SD
Practice Address - Zip Code:57022-1231
Practice Address - Country:US
Practice Address - Phone:605-428-2446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-07
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD2010225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist