Provider Demographics
NPI:1730802448
Name:TISTHAMMER, ALYSON (DPT)
Entity type:Individual
Prefix:
First Name:ALYSON
Middle Name:
Last Name:TISTHAMMER
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 1:1040 N RENGSTORFF AVE STE A4
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94043-1761
Mailing Address - Country:US
Mailing Address - Phone:650-967-5100
Mailing Address - Fax:650-967-5101
Practice Address - Street 1:1040 N RENGSTORFF AVE STE A4
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94043-1761
Practice Address - Country:US
Practice Address - Phone:650-967-5100
Practice Address - Fax:650-967-5101
Is Sole Proprietor?:No
Enumeration Date:2022-09-19
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA302868225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist