Provider Demographics
NPI:1447060801
Name:TALBERT, ALYSSA (DPT)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:TALBERT
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 1:2605 GOOSELEG WAY
Mailing Address - Street 2:
Mailing Address - City:LAKESIDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85929-6595
Mailing Address - Country:US
Mailing Address - Phone:602-531-5315
Mailing Address - Fax:
Practice Address - Street 1:1355 W WHITE MOUNTAIN BLVD STE B
Practice Address - Street 2:
Practice Address - City:LAKESIDE
Practice Address - State:AZ
Practice Address - Zip Code:85929-7068
Practice Address - Country:US
Practice Address - Phone:928-537-2678
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-08
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPT-0340212251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic