Healthcare Provider Details

I. General information

NPI: 1154235232
Provider Name (Legal Business Name): ALYSSA MORELLI ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 ARMOUR ST
DAVIDSON NC
28036-6905
US

IV. Provider business mailing address

166 LAKEVIEW SHORES LOOP
MOORESVILLE NC
28117-6630
US

V. Phone/Fax

Practice location:
  • Phone: 925-783-8522
  • Fax:
Mailing address:
  • Phone: 925-783-8522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberLAT-5554
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: