Provider Demographics
NPI:1861275737
Name:WISSICK, ALANNA VINCENZA (DPT)
Entity type:Individual
Prefix:
First Name:ALANNA
Middle Name:VINCENZA
Last Name:WISSICK
Suffix:
Gender:
Credentials:DPT
Other - Prefix:
Other - First Name:ALANNA
Other - Middle Name:VINCENZA
Other - Last Name:VISCOSI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:1445 CAMBORN DR
Mailing Address - Street 2:
Mailing Address - City:MACEDON
Mailing Address - State:NY
Mailing Address - Zip Code:14502-8829
Mailing Address - Country:US
Mailing Address - Phone:585-690-6652
Mailing Address - Fax:
Practice Address - Street 1:2424 N WYATT DR STE 130
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-6102
Practice Address - Country:US
Practice Address - Phone:520-784-6570
Practice Address - Fax:520-784-6575
Is Sole Proprietor?:No
Enumeration Date:2023-08-15
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPT-033934225100000X
NY050956225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist