Provider Demographics
NPI:1386406502
Name:GRIFFITH, ALYSSA (PTA)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:GRIFFITH
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3401 S 6180 W
Mailing Address - Street 2:
Mailing Address - City:WEST VALLEY CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84128-7503
Mailing Address - Country:US
Mailing Address - Phone:801-889-5920
Mailing Address - Fax:
Practice Address - Street 1:3665 S 8400 W STE 210
Practice Address - Street 2:
Practice Address - City:MAGNA
Practice Address - State:UT
Practice Address - Zip Code:84044-4909
Practice Address - Country:US
Practice Address - Phone:801-250-6733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-24
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12127094-2402225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant