Basic Information
| Provider Information | |||||||||
| NPI: | 1922407899 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LUND | ||||||||
| FirstName: | ALYSSA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 920 4TH ST | ||||||||
| Address2: | |||||||||
| City: | GARRETSON | ||||||||
| State: | SD | ||||||||
| PostalCode: | 570302006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6055943466 | ||||||||
| FaxNumber: | 6055946662 | ||||||||
| Practice Location | |||||||||
| Address1: | 920 4TH ST | ||||||||
| Address2: | |||||||||
| City: | GARRETSON | ||||||||
| State: | SD | ||||||||
| PostalCode: | 570302006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6055943466 | ||||||||
| FaxNumber: | 6055946662 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/17/2014 | ||||||||
| LastUpdateDate: | 08/17/2014 | ||||||||
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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 | 0402 | SD | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.