Provider Demographics
NPI:1831745140
Name:PATTERSON, ALYSSA DENEE (PTA)
Entity type:Individual
Prefix:MISS
First Name:ALYSSA
Middle Name:DENEE
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13756 HIGHWAY 146
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:LA
Mailing Address - Zip Code:71001-5117
Mailing Address - Country:US
Mailing Address - Phone:318-294-4418
Mailing Address - Fax:
Practice Address - Street 1:650 OLIVE ST
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71104-2210
Practice Address - Country:US
Practice Address - Phone:318-302-6000
Practice Address - Fax:318-302-6001
Is Sole Proprietor?:No
Enumeration Date:2019-08-13
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAA10030225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAA10030OtherLOUISIANA PHYSICAL THERAPY BOARD