Provider Demographics
NPI:1417679861
Name:DURAND, ALEXIS (LMT)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:
Last Name:DURAND
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 1:4114 W NOB HILL BLVD
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98908-3900
Mailing Address - Country:US
Mailing Address - Phone:509-985-8177
Mailing Address - Fax:509-972-4001
Practice Address - Street 1:4114 W NOB HILL BLVD
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98908-3900
Practice Address - Country:US
Practice Address - Phone:509-985-8177
Practice Address - Fax:509-972-4001
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-13
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA61335950225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty