Basic Information
| Provider Information | |||||||||
| NPI: | 1578942744 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MROCZKA | ||||||||
| FirstName: | ALYSON | ||||||||
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| OtherLastName: | BULLION | ||||||||
| OtherFirstName: | ALYSON | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2010 MAYBERRY LOOP RD | ||||||||
| Address2: | APT 101B | ||||||||
| City: | MOREHEAD CITY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 285573087 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5173753966 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1011 PORTERS NECK RD | ||||||||
| Address2: | |||||||||
| City: | WILMINGTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 284119196 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9106867195 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/21/2015 | ||||||||
| LastUpdateDate: | 11/18/2015 | ||||||||
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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 | 225200000X | A4903 | NC | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.