Provider Demographics
NPI:1710562269
Name:ALVARADO, MARISSA SUE (LMT)
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:SUE
Last Name:ALVARADO
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:MARISSA
Other - Middle Name:SUE
Other - Last Name:SHIRLING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2857 S MERIDIAN RD STE 100
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-7960
Mailing Address - Country:US
Mailing Address - Phone:208-888-5858
Mailing Address - Fax:208-884-1508
Practice Address - Street 1:2857 S MERIDIAN RD STE 100
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-7960
Practice Address - Country:US
Practice Address - Phone:208-888-5858
Practice Address - Fax:208-884-1508
Is Sole Proprietor?:No
Enumeration Date:2021-03-16
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDMAS-3696225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist