Healthcare Provider Details

I. General information

NPI: 1710484035
Provider Name (Legal Business Name): ALISON DIANE ALDRED LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2018
Last Update Date: 06/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 S SHERMAN ST STE 201
SPOKANE WA
99202-1342
US

IV. Provider business mailing address

2403 S MANITO BLVD
SPOKANE WA
99203-2451
US

V. Phone/Fax

Practice location:
  • Phone: 509-458-7720
  • Fax: 509-777-0432
Mailing address:
  • Phone: 503-307-6988
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number60727172
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: