Provider Demographics
NPI:1932823366
Name:KLOS, ALYSSA MEGAN (DPT)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:MEGAN
Last Name:KLOS
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 1:122 FOX RUN DR
Mailing Address - Street 2:
Mailing Address - City:NATCHITOCHES
Mailing Address - State:LA
Mailing Address - Zip Code:71457-7881
Mailing Address - Country:US
Mailing Address - Phone:954-495-5273
Mailing Address - Fax:
Practice Address - Street 1:21083 N JOHN WAYNE PKWY STE C104
Practice Address - Street 2:
Practice Address - City:MARICOPA
Practice Address - State:AZ
Practice Address - Zip Code:85139-2961
Practice Address - Country:US
Practice Address - Phone:520-233-7555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-29
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA11153R225100000X
FL38317225100000X
AZCP015215T225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist