Provider Demographics
NPI:1487327722
Name:TEAGUE, ALYSSA (DPT)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:TEAGUE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:ALYSSA
Other - Middle Name:
Other - Last Name:SULLIVAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:10709 BLUE SPRUCE LN
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41051-8190
Mailing Address - Country:US
Mailing Address - Phone:859-640-0546
Mailing Address - Fax:
Practice Address - Street 1:3802 TURKEYFOOT RD
Practice Address - Street 2:
Practice Address - City:ELSMERE
Practice Address - State:KY
Practice Address - Zip Code:41018-2838
Practice Address - Country:US
Practice Address - Phone:859-342-0200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-30
Last Update Date:2021-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY007799208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation