MEDICARE: ALYSSA UNTERINER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	2020007690	MO
2	225100000X	Physical Therapist	14438-24	WI

General Provider Information

NPI Number	:	1164902052
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALYSSA UNTERINER

Provider Business Mailing Address
First Line	:	4328 MARYLAND AVE APT 3
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63108-2776
Country	:	US
Telephone Number	:	906-361-9918
Fax Number	:

Provider Business Practice Location Address
First Line	:	1500 GREEN BAY ST
Second Line	:
City	:	LA CROSSE
State	:	WI
Zip	:	54601-6455
Country	:	US
Telephone Number	:	608-784-8125
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/20/2018
Last Update Date	:	02/09/2021

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Directions to “ ALYSSA UNTERINER ” Practice Location

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