Basic Information
| Provider Information | |||||||||
| NPI: | 1811663727 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AMENTA | ||||||||
| FirstName: | ALYSON | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4720 JARDINE RD | ||||||||
| Address2: | |||||||||
| City: | PASO ROBLES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 934469280 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 5255 EL CAMINO REAL | ||||||||
| Address2: | |||||||||
| City: | ATASCADERO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 934223351 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8052370272 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/19/2021 | ||||||||
| LastUpdateDate: | 09/02/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/02/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2251N0400X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Neurology |
ID Information
| ID | Type | State | Issuer | Description | 1811663727 | 05 | CA | MEDICAID |