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General NPI Number Information
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NPI Number | 1619360336
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Entity Type | Individual
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Provider Name | ALYSSA MARIE EASTLAND P.T.A
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Gender | Female
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Dates
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Enumeration Date | 03/05/2015
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Last Update Date | 03/05/2015
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Provider Practice Location Address
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Address Line | 24551 RAYMOND WAY SUITE 125
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City | LAKE FOREST
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State | CA
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Zip | 92630-4400
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Country | US
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Telephone | 949-540-0301
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Fax |
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Provider Business Mailing Address
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Address Line | 33451 BRUSHY HOLLOW DR
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City | YUCAIPA
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State | CA
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Zip | 92399-6404
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Country | US
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Telephone | 714-916-7482
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 10787
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License Number State | CA
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