Healthcare Provider Details

I. General information

NPI: 1306759147
Provider Name (Legal Business Name): ALYSSA JAGODA DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4901 TOWNE CENTRE RD STE 300
SAGINAW MI
48604-2889
US

IV. Provider business mailing address

110 21ST ST
BAY CITY MI
48708-7014
US

V. Phone/Fax

Practice location:
  • Phone: 989-498-5115
  • Fax: 989-498-5123
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501304522
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: