Basic Information
| Provider Information | |||||||||
| NPI: | 1295306454 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | THIERER | ||||||||
| FirstName: | ALYSSA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 503 E 50TH ST UNIT 206 | ||||||||
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| City: | GARDEN CITY | ||||||||
| State: | ID | ||||||||
| PostalCode: | 837141450 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5408780153 | ||||||||
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| Practice Location | |||||||||
| Address1: | 960 S BROADWAY AVE STE 200 | ||||||||
| Address2: | |||||||||
| City: | BOISE | ||||||||
| State: | ID | ||||||||
| PostalCode: | 837063667 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2084339211 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/08/2021 | ||||||||
| LastUpdateDate: | 07/08/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | 7467 | ID | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.