Provider Demographics
NPI:1003576562
Name:SINNER, ALYSSA MARIE (LMT)
Entity Type:Individual
Prefix:MISS
First Name:ALYSSA
Middle Name:MARIE
Last Name:SINNER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:543 42ND AVE S
Mailing Address - Street 2:
Mailing Address - City:MOORHEAD
Mailing Address - State:MN
Mailing Address - Zip Code:56560-6720
Mailing Address - Country:US
Mailing Address - Phone:701-261-6025
Mailing Address - Fax:
Practice Address - Street 1:3140 BLUESTEM DR STE 103
Practice Address - Street 2:
Practice Address - City:WEST FARGO
Practice Address - State:ND
Practice Address - Zip Code:58078-8010
Practice Address - Country:US
Practice Address - Phone:701-893-7878
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-26
Last Update Date:2021-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1516225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist