Healthcare Provider Details

I. General information

NPI: 1700601952
Provider Name (Legal Business Name): ALYSSA REYNOLDS ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2024
Last Update Date: 06/14/2026
Certification Date: 06/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 WATERSCAPE DR
BYRON CENTER MI
49315-7707
US

IV. Provider business mailing address

1015 WATERSCAPE DR
BYRON CENTER MI
49315-7707
US

V. Phone/Fax

Practice location:
  • Phone: 616-206-9031
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: