Provider Demographics
NPI:1912624982
Name:TIEBER, ALYSSA SARAH (DPT, ATC)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:SARAH
Last Name:TIEBER
Suffix:
Gender:F
Credentials:DPT, ATC
Other - Prefix:
Other - First Name:ALYSSA
Other - Middle Name:SARAH
Other - Last Name:GERKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT, ATC
Mailing Address - Street 1:504 TURNSTONE LN
Mailing Address - Street 2:
Mailing Address - City:IMPERIAL BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:91932-2159
Mailing Address - Country:US
Mailing Address - Phone:636-577-4090
Mailing Address - Fax:
Practice Address - Street 1:160 C AVE
Practice Address - Street 2:
Practice Address - City:CORONADO
Practice Address - State:CA
Practice Address - Zip Code:92118-1420
Practice Address - Country:US
Practice Address - Phone:619-658-5589
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-20
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305210408225100000X
CAPT303006225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist