Provider Demographics
NPI:1316691926
Name:MCMINN, ALYSSA HOPE (PT, DPT, LAT, ATC)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:HOPE
Last Name:MCMINN
Suffix:
Gender:F
Credentials:PT, DPT, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 ROUTE 70 STE 19
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08055-2355
Mailing Address - Country:US
Mailing Address - Phone:609-714-3378
Mailing Address - Fax:
Practice Address - Street 1:115 N ROUTE 73 UNIT 80
Practice Address - Street 2:
Practice Address - City:WEST BERLIN
Practice Address - State:NJ
Practice Address - Zip Code:08091-9202
Practice Address - Country:US
Practice Address - Phone:856-335-4938
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-11
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA02073500225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist