Provider Demographics
NPI:1821495102
Name:ROSELL, ALISSA WOLFE (PT, DPT, OMPT, OCS,)
Entity type:Individual
Prefix:
First Name:ALISSA
Middle Name:WOLFE
Last Name:ROSELL
Suffix:
Gender:
Credentials:PT, DPT, OMPT, OCS,
Other - Prefix:DR
Other - First Name:ALISSA
Other - Middle Name:
Other - Last Name:WOLFE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2257 N LOOP 336 W
Mailing Address - Street 2:SUITE 140 PMB 1029
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304
Mailing Address - Country:US
Mailing Address - Phone:323-787-2578
Mailing Address - Fax:
Practice Address - Street 1:2257 N LOOP 336 W
Practice Address - Street 2:SUITE 140 PMB 1029
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304
Practice Address - Country:US
Practice Address - Phone:832-378-7257
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-02
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KST04095225100000X
HIPT-42912251X0800X
171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic