Provider Demographics
NPI:1619841541
Name:PHILLIPS, ALYSSA (PTA)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:PHILLIPS
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 1:253 W E ST
Mailing Address - Street 2:
Mailing Address - City:SUBIACO
Mailing Address - State:AR
Mailing Address - Zip Code:72865-7002
Mailing Address - Country:US
Mailing Address - Phone:479-438-1059
Mailing Address - Fax:479-668-4945
Practice Address - Street 1:257 AIRPORT RD STE G
Practice Address - Street 2:
Practice Address - City:OZARK
Practice Address - State:AR
Practice Address - Zip Code:72949-9266
Practice Address - Country:US
Practice Address - Phone:479-209-0343
Practice Address - Fax:479-668-4945
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-02
Last Update Date:2025-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPTA5068225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty