Basic Information
| Provider Information | |||||||||
| NPI: | 1831811801 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VONDER HAAR | ||||||||
| FirstName: | ALYSSA | ||||||||
| MiddleName: | LYNN | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 418 W 3RD ST | ||||||||
| Address2: | |||||||||
| City: | OWENSBORO | ||||||||
| State: | KY | ||||||||
| PostalCode: | 423010704 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2709268145 | ||||||||
| FaxNumber: | 2709268147 | ||||||||
| Practice Location | |||||||||
| Address1: | 418 W 3RD ST | ||||||||
| Address2: | |||||||||
| City: | OWENSBORO | ||||||||
| State: | KY | ||||||||
| PostalCode: | 423010704 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2709268145 | ||||||||
| FaxNumber: | 2709268147 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/15/2022 | ||||||||
| LastUpdateDate: | 09/15/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/15/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | CP014672T | KY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.