Provider Demographics
NPI:1902324825
Name:KANO, ALYSSA AKEMI (DPT)
Entity Type:Individual
Prefix:MS
First Name:ALYSSA
Middle Name:AKEMI
Last Name:KANO
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MS
Other - First Name:ALYSSA
Other - Middle Name:AKEMI
Other - Last Name:KANO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPT
Mailing Address - Street 1:10 CONGRESS ST STE 103
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-3027
Mailing Address - Country:US
Mailing Address - Phone:626-795-0282
Mailing Address - Fax:626-795-4236
Practice Address - Street 1:10 CONGRESS STREET
Practice Address - Street 2:SUITE #103
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-3027
Practice Address - Country:US
Practice Address - Phone:626-795-0282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-30
Last Update Date:2017-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA293363225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist