Healthcare Provider Details

I. General information

NPI: 1275440463
Provider Name (Legal Business Name): ALISSA JANIECE LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38579 SE RIVER ST
SNOQUALMIE WA
98065-5155
US

IV. Provider business mailing address

25920 112TH AVE SE APT C108
KENT WA
98030-7133
US

V. Phone/Fax

Practice location:
  • Phone: 251-609-1414
  • Fax:
Mailing address:
  • Phone: 251-609-1414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMASS.MA.70117884
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: