Healthcare Provider Details

I. General information

NPI: 1093646481
Provider Name (Legal Business Name): ALYSSA HAWLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1470 HOLLIPARK DR STE A
IDAHO FALLS ID
83401-2160
US

IV. Provider business mailing address

3446 W 3700 N
MOORE ID
83255-8776
US

V. Phone/Fax

Practice location:
  • Phone: 208-754-2127
  • Fax:
Mailing address:
  • Phone: 208-881-6246
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number7281315
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: