=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326909664
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALYSSA MCCULLOUGH PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/18/2025
-----------------------------------------------------
Last Update Date | 11/18/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12514 HIGH MEADOW DR
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75244-7027
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 412-913-6792
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12514 HIGH MEADOW DR
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75244-7027
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 412-913-6792
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | ALYSSA MCCULLOUGH
-----------------------------------------------------
Credential | PT, DPT
-----------------------------------------------------
Telephone | 412-913-6792
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------