Provider Demographics
NPI:1356759419
Name:BOLGER, ALYSSA MICHELLE (DPT)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:MICHELLE
Last Name:BOLGER
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 1:4465 MEADOW VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50265-2083
Mailing Address - Country:US
Mailing Address - Phone:515-306-7215
Mailing Address - Fax:
Practice Address - Street 1:5627 NW 86TH ST
Practice Address - Street 2:#200
Practice Address - City:JOHNSTON
Practice Address - State:IA
Practice Address - Zip Code:50131-1738
Practice Address - Country:US
Practice Address - Phone:515-270-0303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-31
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA072530225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist