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General NPI Number Information
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NPI Number | 1235930900
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Entity Type | Individual
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Provider Name | LAEISHA ALDRIDGE LMT
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Gender | Female
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Dates
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Enumeration Date | 03/20/2025
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Last Update Date | 03/20/2025
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Provider Practice Location Address
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Address Line | 4717 W MAIN ST STE 1A
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City | BELLEVILLE
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State | IL
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Zip | 62226-5296
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Country | US
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Telephone | 618-720-0016
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Fax |
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Provider Business Mailing Address
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Address Line | 732 N 38TH ST
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City | EAST SAINT LOUIS
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State | IL
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Zip | 62205-2108
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Country | US
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Telephone | 314-898-5571
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 22702210
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License Number State | IL
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