Provider Demographics
NPI:1972117463
Name:BESCH, ALYSSA (PT, DPT)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:BESCH
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:331 E ROOSEVELT CIR APT 211
Mailing Address - Street 2:
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-6962
Mailing Address - Country:US
Mailing Address - Phone:952-239-5776
Mailing Address - Fax:
Practice Address - Street 1:102 E NORTH ST
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:MN
Practice Address - Zip Code:56048-9793
Practice Address - Country:US
Practice Address - Phone:507-231-5113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-02
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN12012225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist