Healthcare Provider Details

I. General information

NPI: 1447643655
Provider Name (Legal Business Name): ALYSSA MADISON DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALYSSA PAGLIA DPT

II. Dates (important events)

Enumeration Date: 03/12/2015
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25311 LITTLE MACK AVE STE A
SAINT CLAIR SHORES MI
48081-3301
US

IV. Provider business mailing address

33900 HARPER AVE SUITE 104
CLINTON TOWNSHIP MI
48035-4258
US

V. Phone/Fax

Practice location:
  • Phone: 586-771-4900
  • Fax: 586-771-4993
Mailing address:
  • Phone: 586-416-9100
  • Fax: 586-416-9103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501017081
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: