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General NPI Number Information
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NPI Number | 1932823366
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Entity Type | Individual
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Provider Name | ALYSSA MEGAN KLOS DPT
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Gender | Female
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Dates
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Enumeration Date | 09/29/2022
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Last Update Date | 09/29/2022
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Provider Practice Location Address
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Address Line | 21083 N JOHN WAYNE PKWY STE C104
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City | MARICOPA
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State | AZ
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Zip | 85139-2961
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Country | US
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Telephone | 520-233-7555
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Fax |
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Provider Business Mailing Address
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Address Line | 122 FOX RUN DR
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City | NATCHITOCHES
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State | LA
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Zip | 71457-7881
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Country | US
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Telephone | 954-495-5273
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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 | 11153R
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License Number State | LA
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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 | 38317
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | CP015215T
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License Number State | AZ
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