| NPI | 1588137020 |
|---|---|
| Former Name | ALYSSA LYNN DITTMER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MO 2022030328) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KS 11-07055) |
| 225100000X Physical Therapist (Licence: MO 2022030328) | |
| 2255A2300X Specialist/Technologist Athletic Trainer | |
| Enumeration Date | 2019-01-08 |
| Last Update Date | 2024-01-18 |