Provider Demographics
NPI:1144433137
Name:COX, ALISA DAWN (DPT)
Entity type:Individual
Prefix:
First Name:ALISA
Middle Name:DAWN
Last Name:COX
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:ALISA
Other - Middle Name:DAWN
Other - Last Name:BERGROOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:KRMC OUTPATIENT THERAPY SERVICES AT THE SUMMIT
Mailing Address - Street 2:205 SUNNYVIEW LANE
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901
Mailing Address - Country:US
Mailing Address - Phone:406-751-4520
Mailing Address - Fax:406-751-4526
Practice Address - Street 1:KRMC OUTPATIENT THERAPY SERVICES AT THE SUMMIT
Practice Address - Street 2:205 SUNNYVIEW LANE
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901
Practice Address - Country:US
Practice Address - Phone:406-751-4520
Practice Address - Fax:406-751-4526
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1428PT225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist