Healthcare Provider Details

I. General information

NPI: 1760168165
Provider Name (Legal Business Name): ALYSSA CARRASCO DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2023
Last Update Date: 06/22/2023
Certification Date: 06/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6434 98TH ST STE 100
LUBBOCK TX
79424-5468
US

IV. Provider business mailing address

6434 98TH ST STE 100
LUBBOCK TX
79424-5468
US

V. Phone/Fax

Practice location:
  • Phone: 866-832-1708
  • Fax: 888-789-4391
Mailing address:
  • Phone: 866-832-1708
  • Fax: 888-789-4391

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1378061
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: