Provider Demographics
NPI:1811516339
Name:HAVESON, ALYSSA (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:ALYSSA
Middle Name:
Last Name:HAVESON
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 CLIFF RD
Mailing Address - Street 2:
Mailing Address - City:BENSALEM
Mailing Address - State:PA
Mailing Address - Zip Code:19020-4069
Mailing Address - Country:US
Mailing Address - Phone:862-754-2126
Mailing Address - Fax:862-754-2126
Practice Address - Street 1:725 CLIFF RD
Practice Address - Street 2:
Practice Address - City:BENSALEM
Practice Address - State:PA
Practice Address - Zip Code:19020-4069
Practice Address - Country:US
Practice Address - Phone:862-754-2126
Practice Address - Fax:862-754-2126
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-14
Last Update Date:2025-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT028188261QP2000X
NJ40QA01917700261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy