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General NPI Number Information
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NPI Number | 1699954719
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Entity Type | Individual
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Provider Name | ALISSA SIEMERS MSED, ATC, VATL
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Gender | Female
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Dates
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Enumeration Date | 10/25/2007
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Last Update Date | 07/06/2008
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Provider Practice Location Address
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Address Line | 5800 MARSHALL AVE
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City | NEWPORT NEWS
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State | VA
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Zip | 23605-2420
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Country | US
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Telephone | 757-570-4184
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Fax |
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Provider Business Mailing Address
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Address Line | 419 MARYLAND AVE
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City | PORTSMOUTH
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State | VA
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Zip | 23707-2119
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Country | US
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Telephone |
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 0126001057
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License Number State | VA
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