Provider Demographics
NPI:1396408324
Name:CARUSO, AALIYAH NOELLE (LMT)
Entity Type:Individual
Prefix:
First Name:AALIYAH
Middle Name:NOELLE
Last Name:CARUSO
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:AALIYAH
Other - Middle Name:NOELLE
Other - Last Name:CARUSO-DONN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 877816
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99687-7816
Mailing Address - Country:US
Mailing Address - Phone:907-841-3725
Mailing Address - Fax:
Practice Address - Street 1:124 W SWANSON AVE STE 1
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-6822
Practice Address - Country:US
Practice Address - Phone:907-414-1730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-17
Last Update Date:2021-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK181179225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist