Healthcare Provider Details

I. General information

NPI: 1649747270
Provider Name (Legal Business Name): ALYSSA M BOYER PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALYSSA POLLASTRINI

II. Dates (important events)

Enumeration Date: 11/01/2018
Last Update Date: 10/10/2025
Certification Date: 10/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10590 N PORT WASHINGTON RD
MEQUON WI
53092-5537
US

IV. Provider business mailing address

10405 N GREENSIDE CT
MEQUON WI
53092-5109
US

V. Phone/Fax

Practice location:
  • Phone: 262-375-1075
  • Fax: 262-375-4975
Mailing address:
  • Phone: 815-893-8480
  • Fax: 815-893-8481

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number14400-24
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: