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General NPI Number Information
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NPI Number | 1164902052
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Entity Type | Individual
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Provider Name | ALYSSA UNTERINER
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Gender | Female
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Dates
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Enumeration Date | 08/20/2018
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Last Update Date | 02/09/2021
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Provider Practice Location Address
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Address Line | 1500 GREEN BAY ST
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City | LA CROSSE
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State | WI
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Zip | 54601-6455
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Country | US
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Telephone | 608-784-8125
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Fax |
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Provider Business Mailing Address
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Address Line | 4328 MARYLAND AVE APT 3
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City | SAINT LOUIS
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State | MO
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Zip | 63108-2776
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Country | US
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Telephone | 906-361-9918
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 2020007690
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 14438-24
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License Number State | WI
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