Provider Demographics
NPI:1952802050
Name:VARTON, ALISSA RAE (DPT)
Entity Type:Individual
Prefix:
First Name:ALISSA
Middle Name:RAE
Last Name:VARTON
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 1:2552 MONROE ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-3014
Mailing Address - Country:US
Mailing Address - Phone:313-278-7800
Mailing Address - Fax:313-730-9880
Practice Address - Street 1:2552 MONROE ST
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-3014
Practice Address - Country:US
Practice Address - Phone:313-278-7800
Practice Address - Fax:313-730-9880
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-23
Last Update Date:2018-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1487605168Medicaid