Basic Information
| Provider Information | |||||||||
| NPI: | 1194130781 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KEY | ||||||||
| FirstName: | ALYSON | ||||||||
| MiddleName: | RAE | ||||||||
| NamePrefix: | |||||||||
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| Credential: | DPT | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | SNELL | ||||||||
| OtherFirstName: | ALYSON | ||||||||
| OtherMiddleName: | R | ||||||||
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| OtherCredential: | DPT | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1111 EARL FRYE BLVD | ||||||||
| Address2: | |||||||||
| City: | AMORY | ||||||||
| State: | MS | ||||||||
| PostalCode: | 388215516 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6622574048 | ||||||||
| FaxNumber: | 6622574080 | ||||||||
| Practice Location | |||||||||
| Address1: | 1111 EARL FRYE BLVD | ||||||||
| Address2: | |||||||||
| City: | AMORY | ||||||||
| State: | MS | ||||||||
| PostalCode: | 388215516 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6622574048 | ||||||||
| FaxNumber: | 6622574080 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/23/2014 | ||||||||
| LastUpdateDate: | 06/01/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 5538 | MS | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.