Provider Demographics
NPI:1053985531
Name:CHMIELEWSKI, ALYSSA KAY (DPT)
Entity type:Individual
Prefix:DR
First Name:ALYSSA
Middle Name:KAY
Last Name:CHMIELEWSKI
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 WHITE BIRCH TRL
Mailing Address - Street 2:
Mailing Address - City:SUPERIOR
Mailing Address - State:WI
Mailing Address - Zip Code:54880-5305
Mailing Address - Country:US
Mailing Address - Phone:218-343-6094
Mailing Address - Fax:
Practice Address - Street 1:1555 HERITAGE BLVD
Practice Address - Street 2:
Practice Address - City:WEST SALEM
Practice Address - State:WI
Practice Address - Zip Code:54669-9404
Practice Address - Country:US
Practice Address - Phone:608-786-4989
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-18
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT040.0134190225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist