Healthcare Provider Details

I. General information

NPI: 1275459380
Provider Name (Legal Business Name): ALYSSA CARRUS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

63 PARK ST STE 303
ANDOVER MA
01810-3665
US

IV. Provider business mailing address

59 HUNTERS RUN PL
HAVERHILL MA
01832-3640
US

V. Phone/Fax

Practice location:
  • Phone: 774-521-7813
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number2436
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: