Provider Demographics
NPI:1215680426
Name:WILLIAMS, ALYSSA (LAT, ATC)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:709 KINDRED LN
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-3112
Mailing Address - Country:US
Mailing Address - Phone:570-594-1627
Mailing Address - Fax:
Practice Address - Street 1:709 KINDRED LN
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-3112
Practice Address - Country:US
Practice Address - Phone:570-594-1627
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-28
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT62542255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer