Provider Demographics
NPI:1831811801
Name:VONDER HAAR, ALYSSA LYNN (DPT)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:LYNN
Last Name:VONDER HAAR
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 1:418 W 3RD ST
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42301-0704
Mailing Address - Country:US
Mailing Address - Phone:270-926-8145
Mailing Address - Fax:270-926-8147
Practice Address - Street 1:418 W 3RD ST
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42301-0704
Practice Address - Country:US
Practice Address - Phone:270-926-8145
Practice Address - Fax:270-926-8147
Is Sole Proprietor?:No
Enumeration Date:2022-09-15
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYCP014672T225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist