Provider Demographics
NPI:1710466123
Name:LASSITER, ALETHA L (BS, LMT, RYT 200)
Entity Type:Individual
Prefix:
First Name:ALETHA
Middle Name:L
Last Name:LASSITER
Suffix:
Gender:F
Credentials:BS, LMT, RYT 200
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1155 SE PRO MALL BLVD TRLR 314
Mailing Address - Street 2:
Mailing Address - City:PULLMAN
Mailing Address - State:WA
Mailing Address - Zip Code:99163-5434
Mailing Address - Country:US
Mailing Address - Phone:208-310-1279
Mailing Address - Fax:
Practice Address - Street 1:246 E MAIN ST
Practice Address - Street 2:
Practice Address - City:PULLMAN
Practice Address - State:WA
Practice Address - Zip Code:99163-2619
Practice Address - Country:US
Practice Address - Phone:208-310-1279
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-08
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDMAS-3485225700000X
WA60847751225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA101676119OtherPREMARA BLUE CROSS