MEDICARE: ALYSSA BALTRUSCH

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	363A00000X	Physician Assistant	PA228852	OR
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1598575136
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALYSSA BALTRUSCH

Provider Business Mailing Address
First Line	:	3355 RIVERBEND DR STE 300
Second Line	:
City	:	SPRINGFIELD
State	:	OR
Zip	:	97477-8800
Country	:	US
Telephone Number	:	541-222-8333
Fax Number	:

Provider Business Practice Location Address
First Line	:	1775 N SECTOR CT STE 200
Second Line	:
City	:	WINCHESTER
State	:	VA
Zip	:	22601-2859
Country	:	US
Telephone Number	:	540-542-6208
Fax Number	:

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

Provider Enumeration Date	:	01/07/2025
Last Update Date	:	02/17/2026

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Directions to “ ALYSSA BALTRUSCH ” Practice Location

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