Healthcare Provider Details

I. General information

NPI: 1871947200
Provider Name (Legal Business Name): ALYSIA CLAWSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2016
Last Update Date: 01/09/2024
Certification Date: 01/09/2024
Deactivation Date: 10/20/2017
Reactivation Date: 09/16/2020

III. Provider practice location address

2765 JEFFERSON DAVIS HWY STE 203
STAFFORD VA
22554-8331
US

IV. Provider business mailing address

1345 ENTERPRISE DR
WEST CHESTER PA
19380-5964
US

V. Phone/Fax

Practice location:
  • Phone: 540-446-5323
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number301102
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: