Provider Demographics
NPI:1407545858
Name:DAVIS, ALYSSA KORINNE (LMT)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:KORINNE
Last Name:DAVIS
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 1:213 ONTARIO STREET EXT
Mailing Address - Street 2:
Mailing Address - City:CANANDAIGUA
Mailing Address - State:NY
Mailing Address - Zip Code:14424-1831
Mailing Address - Country:US
Mailing Address - Phone:585-430-8546
Mailing Address - Fax:
Practice Address - Street 1:7353 STATE ROUTE 96
Practice Address - Street 2:BLDG 1, SUITE 103A
Practice Address - City:VICTOR
Practice Address - State:NY
Practice Address - Zip Code:14564
Practice Address - Country:US
Practice Address - Phone:585-430-8546
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-02
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027383225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist