Provider Demographics
NPI:1093452955
Name:LLITERAS IZA, ALEXIS (LMT)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:
Last Name:LLITERAS IZA
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 1:1033 N TACOMA AVE
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98403-2928
Mailing Address - Country:US
Mailing Address - Phone:253-474-9670
Mailing Address - Fax:
Practice Address - Street 1:1033 N TACOMA AVE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98403-2928
Practice Address - Country:US
Practice Address - Phone:253-474-9670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-12
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA61299017225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist