Provider Demographics
NPI:1124492061
Name:O'CONNOR, ALYSON (DPT)
Entity type:Individual
Prefix:
First Name:ALYSON
Middle Name:
Last Name:O'CONNOR
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 1:14221 EUCLID ST STE F
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92843-4991
Mailing Address - Country:US
Mailing Address - Phone:714-891-2739
Mailing Address - Fax:714-891-2747
Practice Address - Street 1:11190 WARNER AVE STE 309
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-4047
Practice Address - Country:US
Practice Address - Phone:714-891-2739
Practice Address - Fax:714-891-2747
Is Sole Proprietor?:No
Enumeration Date:2015-11-16
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42782225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB262571Medicare UPIN