Alyssa Colleen Tendall Stout, ATC

Primary specialty

Sports Medicine (Physical Medicine & Rehabilitation) PhysicianTaxonomy code 2081S0010X

License

AT005607 Issued in OH

Practice address

215 5TH St
Marietta, OH 45750-4033

Phone

(740) 376-4575

NPI assigned

Oct 21, 2014

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other identifiers 1

Other names 1

• Alyssa Colleen Tendall Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1413849600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1549843200000",
    "number": "1487058343",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "215 5TH ST",
            "city": "MARIETTA",
            "state": "OH",
            "postal_code": "457504033",
            "telephone_number": "515-231-1327"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "215 5TH ST",
            "city": "MARIETTA",
            "state": "OH",
            "postal_code": "457504033",
            "telephone_number": "740-376-4575"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "116 Ward",
            "address_2": "Sports Medicine Building",
            "address_purpose": "LOCATION",
            "city": "Greenville",
            "state": "NC",
            "postal_code": "27858",
            "country_code": "US",
            "telephone_number": "252-737-0089",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "215 5th St",
            "address_purpose": "LOCATION",
            "city": "Marietta",
            "state": "OH",
            "postal_code": "457504033",
            "country_code": "US",
            "telephone_number": "740-376-4575",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "STOUT",
        "first_name": "ALYSSA",
        "middle_name": "COLLEEN TENDALL",
        "credential": "ATC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-10-21",
        "last_updated": "2019-02-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225400000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation Practitioner",
            "state": "OH",
            "license": "AT005607",
            "primary": false
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "OH",
            "license": "AT005607",
            "primary": false
        },
        {
            "code": "2081S0010X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation, Sports Medicine",
            "state": "OH",
            "license": "AT005607",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ATHLETIC TRAINER",
            "identifier": "AT005607",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ALYSSA",
            "last_name": "TENDALL",
            "middle_name": "COLLEEN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Robert B. Stickrath, D.D.S.
• Jaden Stine, COTA/L
• Vince E Stollar
• Jessica Eileen Stolz, RN,MSN,C-FNP
• Mark A Stonehill, M.D.
• Samantha Nichole Strahler, CNP
• Debbie Streight
• Kristen Ellen Stritz, PTA
• Ann Chadwick Stump, OTR
• Lacie Sturm

• Sports Medicine (Physical Medicine & Rehabilitation) Physician in Marietta, OH
• Providers in Marietta, OH by specialty
• Sports Medicine (Physical Medicine & Rehabilitation) Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.