Healthcare Provider Details

I. General information

NPI: 1184558785
Provider Name (Legal Business Name): ALYSSA ROBERTSON DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1118 N RECKER RD STE 109
MESA AZ
85205-5540
US

IV. Provider business mailing address

1118 N RECKER RD STE 109
MESA AZ
85205-5540
US

V. Phone/Fax

Practice location:
  • Phone: 480-833-2778
  • Fax:
Mailing address:
  • Phone: 480-833-2778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number034813
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: