=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053697953
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALISSA KATHRYN PARISH PT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/24/2011
-----------------------------------------------------
Last Update Date | 03/14/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 311 SERVICE ROAD
-----------------------------------------------------
City | EAST SANDWICH
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02537
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-740-8752
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 30 GREEN POND RD
-----------------------------------------------------
City | EAST FALMOUTH
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02536
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-740-8752
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 19792
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------