Provider Demographics
NPI:1104149475
Name:NEWMAN, ALYSIA R (PT)
Entity type:Individual
Prefix:
First Name:ALYSIA
Middle Name:R
Last Name:NEWMAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:ALYSIA
Other - Middle Name:R
Other - Last Name:PARKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:2015 HIGHPOINTE DR
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39272-8974
Mailing Address - Country:US
Mailing Address - Phone:888-976-2667
Mailing Address - Fax:601-824-8828
Practice Address - Street 1:236 CALDWELL DR
Practice Address - Street 2:
Practice Address - City:HAZLEHURST
Practice Address - State:MS
Practice Address - Zip Code:39083-2723
Practice Address - Country:US
Practice Address - Phone:601-894-9004
Practice Address - Fax:601-894-3004
Is Sole Proprietor?:No
Enumeration Date:2010-03-01
Last Update Date:2015-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT3038225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist