Provider Demographics
NPI:1194130781
Name:KEY, ALYSON RAE (DPT)
Entity type:Individual
Prefix:
First Name:ALYSON
Middle Name:RAE
Last Name:KEY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:ALYSON
Other - Middle Name:R
Other - Last Name:SNELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:1111 EARL FRYE BLVD
Mailing Address - Street 2:
Mailing Address - City:AMORY
Mailing Address - State:MS
Mailing Address - Zip Code:38821-5516
Mailing Address - Country:US
Mailing Address - Phone:662-257-4048
Mailing Address - Fax:662-257-4080
Practice Address - Street 1:1111 EARL FRYE BLVD
Practice Address - Street 2:
Practice Address - City:AMORY
Practice Address - State:MS
Practice Address - Zip Code:38821-5516
Practice Address - Country:US
Practice Address - Phone:662-257-4048
Practice Address - Fax:662-257-4080
Is Sole Proprietor?:No
Enumeration Date:2014-06-23
Last Update Date:2015-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS5538225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS352346YNB2Medicare Oscar/Certification