Provider Demographics
NPI:1720657240
Name:WILLIAMS, ALYSSA RENAE (LAT, ATC)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:RENAE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 RACE ST APT 8302
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70130-8640
Mailing Address - Country:US
Mailing Address - Phone:316-880-8465
Mailing Address - Fax:
Practice Address - Street 1:6823 SAINT CHARLES AVE
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70118-5698
Practice Address - Country:US
Practice Address - Phone:316-880-8465
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-19
Last Update Date:2021-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3271282255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSK03445639OtherDRIVER'S LICENSE