Healthcare Provider Details

I. General information

NPI: 1023881083
Provider Name (Legal Business Name): ALYSA MAE BEYERS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2023
Last Update Date: 11/01/2023
Certification Date: 10/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5184 S BROADWAY
ENGLEWOOD CO
80113
US

IV. Provider business mailing address

4090 S BANNOCK ST APT 204
ENGLEWOOD CO
80110-4660
US

V. Phone/Fax

Practice location:
  • Phone: 720-372-0865
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number0015392
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: