Basic Information
| Provider Information | |||||||||
| NPI: | 1952700312 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | TRETTEL | ||||||||
| FirstName: | ALYSSA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 39 CINEMA BLVD | ||||||||
| Address2: | |||||||||
| City: | LEOMINSTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 014533290 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9784666677 | ||||||||
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| Practice Location | |||||||||
| Address1: | 39 CINEMA BLVD | ||||||||
| Address2: | |||||||||
| City: | LEOMINSTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 014533290 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9784666677 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/21/2014 | ||||||||
| LastUpdateDate: | 01/07/2019 | ||||||||
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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 | 21323 | MA | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | 010431 | CT | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.