Provider Demographics
NPI:1245303015
Name:SUBBERT, ALYSSA LEANNE (PT)
Entity type:Individual
Prefix:MRS
First Name:ALYSSA
Middle Name:LEANNE
Last Name:SUBBERT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1009 DOLAN DR
Mailing Address - Street 2:
Mailing Address - City:GRIMES
Mailing Address - State:IA
Mailing Address - Zip Code:50111-1028
Mailing Address - Country:US
Mailing Address - Phone:515-778-3926
Mailing Address - Fax:
Practice Address - Street 1:205 NE DARTMOOR DRIVE
Practice Address - Street 2:
Practice Address - City:WAUKEE
Practice Address - State:IA
Practice Address - Zip Code:50263
Practice Address - Country:US
Practice Address - Phone:515-987-6267
Practice Address - Fax:515-987-6269
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02888208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA(0) 449579Medicaid
IA(0) 449579Medicaid