Provider Demographics
NPI:1285178111
Name:DICKERSON, ALYSSA JEAN (PT, DPT)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:JEAN
Last Name:DICKERSON
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:ALYSSA
Other - Middle Name:JEAN
Other - Last Name:RACHUBKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1265 SGT JON STILES DR UNIT D
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80129-2266
Mailing Address - Country:US
Mailing Address - Phone:303-274-7332
Mailing Address - Fax:720-497-6733
Practice Address - Street 1:1265 SGT JON STILES DR UNIT D
Practice Address - Street 2:
Practice Address - City:HIGHLANDS RANCH
Practice Address - State:CO
Practice Address - Zip Code:80129
Practice Address - Country:US
Practice Address - Phone:303-274-7332
Practice Address - Fax:720-497-6733
Is Sole Proprietor?:No
Enumeration Date:2016-12-12
Last Update Date:2018-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016039469225100000X
CO15831225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist