Healthcare Provider Details

I. General information

NPI: 1811790991
Provider Name (Legal Business Name): ALLYSA WILSON BEERS TRS, CTRS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALLYSA WILSON TRS, CTRS

II. Dates (important events)

Enumeration Date: 04/01/2025
Last Update Date: 04/01/2025
Certification Date: 04/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

228 W 400 N
SARATOGA SPRINGS UT
84045-3102
US

IV. Provider business mailing address

5500 MING AVE STE 265
BAKERSFIELD CA
93309-4696
US

V. Phone/Fax

Practice location:
  • Phone: 385-715-4410
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225800000X
TaxonomyRecreation Therapist
License Number6875400-4002
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: