Provider Demographics
NPI:1306361506
Name:CHONG, ALYSSA KATHLEEN (LMT RDA)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:KATHLEEN
Last Name:CHONG
Suffix:
Gender:F
Credentials:LMT RDA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8400 FARM RD STE 150
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89131-8169
Mailing Address - Country:US
Mailing Address - Phone:702-209-2722
Mailing Address - Fax:
Practice Address - Street 1:8400 FARM RD STE 150
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89131-8169
Practice Address - Country:US
Practice Address - Phone:702-209-2722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNVMT.5985225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist