Provider Demographics
NPI:1124487343
Name:ERB, ALYSSA MICHELLE (ATC)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:MICHELLE
Last Name:ERB
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:ALYSSA
Other - Middle Name:MICHELLE
Other - Last Name:ALPERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5049 HERSHOLT AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90712-2728
Mailing Address - Country:US
Mailing Address - Phone:951-704-3466
Mailing Address - Fax:
Practice Address - Street 1:5049 HERSHOLT AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90712-2728
Practice Address - Country:US
Practice Address - Phone:951-704-3466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-16
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20000045032255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer