Provider Demographics
NPI:1194093377
Name:KING, ALYSE (MS, AT)
Entity type:Individual
Prefix:
First Name:ALYSE
Middle Name:
Last Name:KING
Suffix:
Gender:F
Credentials:MS, AT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:591 JOSEPH E GOTTFRIED DR
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36688-0001
Mailing Address - Country:US
Mailing Address - Phone:251-341-4036
Mailing Address - Fax:251-445-9568
Practice Address - Street 1:591 JOSEPH E GOTTFRIED DR
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36688-0001
Practice Address - Country:US
Practice Address - Phone:251-341-4036
Practice Address - Fax:251-445-9568
Is Sole Proprietor?:No
Enumeration Date:2011-12-02
Last Update Date:2012-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT.0034502255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer