| Doctor Name: | ALISSE INDRELIE |
| NPI Number: | 1063811552 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 9689 |
| Business Practice Address: | 2785 White Bear Ave N Ste 108a Maplewood, MN - 551091320 |
| Business Phone Number: | 6514150418 |
| Business Fax Number: | |
| Mailing Address: | 2785 White Bear Ave N Ste 108a, MAPLEWOOD |
| State: | MN |
| Postal Code: | 551091320 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 08/20/2014 |
| NPI Last Update Date: | 08/20/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2251G0304X |
| License Number: | 9689 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MN |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | Geriatrics |
| Taxonomy Definition: | |