Healthcare Provider Details

I. General information

NPI: 1295571750
Provider Name (Legal Business Name): ALYSSA BROWN CREASY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2024
Last Update Date: 05/21/2025
Certification Date: 05/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3543 E MERIDIAN PARK LOOP STE C
WASILLA AK
99654-7233
US

IV. Provider business mailing address

460 ELKHORN RD
PARIS TN
38242-6980
US

V. Phone/Fax

Practice location:
  • Phone: 907-864-0099
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number15553
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number234157
License Number StateAK

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: