Provider Demographics
NPI:1841791308
Name:JESSOP, ALEXANDRIA LADAUN (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:
First Name:ALEXANDRIA
Middle Name:LADAUN
Last Name:JESSOP
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:CONNECT MASSAGE
Other - Middle Name:
Other - Last Name:LLC
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:118 N 8TH ST
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:MT
Mailing Address - Zip Code:59840-2302
Mailing Address - Country:US
Mailing Address - Phone:406-381-4253
Mailing Address - Fax:
Practice Address - Street 1:3946 US HIGHWAY 93 N
Practice Address - Street 2:
Practice Address - City:STEVENSVILLE
Practice Address - State:MT
Practice Address - Zip Code:59870-6425
Practice Address - Country:US
Practice Address - Phone:406-381-4253
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-21
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT13825225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist