Provider Demographics
NPI:1417841750
Name:ANDERSON, ALYSSA R (DPT)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:R
Last Name:ANDERSON
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 1:5620 RAINIER AVE S # 102
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98118-2498
Mailing Address - Country:US
Mailing Address - Phone:206-535-8061
Mailing Address - Fax:206-535-8064
Practice Address - Street 1:5620 RAINIER AVE S # 102
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98118-2498
Practice Address - Country:US
Practice Address - Phone:206-535-8061
Practice Address - Fax:206-535-8064
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-03
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT61665465225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist