Healthcare Provider Details

I. General information

NPI: 1528507423
Provider Name (Legal Business Name): ALISA ALEXIS LMP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2017
Last Update Date: 03/10/2023
Certification Date: 03/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13215 SE 240TH ST STE D
KENT WA
98042-5120
US

IV. Provider business mailing address

PO BOX 5718
KALISPELL MT
59903-5718
US

V. Phone/Fax

Practice location:
  • Phone: 253-631-3026
  • Fax: 253-631-3899
Mailing address:
  • Phone: 406-756-0134
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA60731707
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberP160468915
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: