Provider Demographics
NPI:1154509974
Name:MASSEY, ALISHA MICHALLE (DPT)
Entity Type:Individual
Prefix:
First Name:ALISHA
Middle Name:MICHALLE
Last Name:MASSEY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12684 TWO LAKE LN
Mailing Address - Street 2:
Mailing Address - City:COLLINSVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39325-9024
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6434 DALE DR
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:MS
Practice Address - Zip Code:39342-8704
Practice Address - Country:US
Practice Address - Phone:601-483-4285
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-04
Last Update Date:2022-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT1302225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist