Provider Demographics
NPI:1699112813
Name:WISCHMEYER, ALYSSA CELESTE (PT)
Entity type:Individual
Prefix:MISS
First Name:ALYSSA
Middle Name:CELESTE
Last Name:WISCHMEYER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 BROWNSWITCH RD STE 2
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458-1262
Mailing Address - Country:US
Mailing Address - Phone:985-641-2866
Mailing Address - Fax:985-641-2866
Practice Address - Street 1:720 BROWNSWITCH RD STE 2
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-1262
Practice Address - Country:US
Practice Address - Phone:985-641-2866
Practice Address - Fax:985-641-2866
Is Sole Proprietor?:No
Enumeration Date:2013-05-29
Last Update Date:2013-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA08563225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist