Provider Demographics
NPI:1417686205
Name:LARSON, ALYSSA (DPT)
Entity type:Individual
Prefix:DR
First Name:ALYSSA
Middle Name:
Last Name:LARSON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:DR
Other - First Name:ALYSSA
Other - Middle Name:
Other - Last Name:COONROD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:7849 TRAMWAY BLVD NE STE A
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87122-2529
Mailing Address - Country:US
Mailing Address - Phone:505-821-3831
Mailing Address - Fax:
Practice Address - Street 1:2113 GOLF COURSE RD SE
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-1656
Practice Address - Country:US
Practice Address - Phone:505-898-9700
Practice Address - Fax:505-212-6991
Is Sole Proprietor?:No
Enumeration Date:2022-06-07
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPT6111225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist