Provider Demographics
NPI:1689221392
Name:HERRERA, ALYSSA MARIE (DPT)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:MARIE
Last Name:HERRERA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:ALYSSA
Other - Middle Name:MARIE
Other - Last Name:JANSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:1486 GRAEBER STREET P.O. BOX 6550
Mailing Address - Street 2:
Mailing Address - City:MARCH AIR RESERVE BASE
Mailing Address - State:CA
Mailing Address - Zip Code:92518
Mailing Address - Country:US
Mailing Address - Phone:262-408-1520
Mailing Address - Fax:
Practice Address - Street 1:39815 ALTA MURRIETA DRIVE
Practice Address - Street 2:SUITE C-1
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92563
Practice Address - Country:US
Practice Address - Phone:951-304-7673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-19
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
CAPT298952225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist