Provider Demographics
NPI:1952650699
Name:FLEMING, ALEESHA BREANN (LMP)
Entity Type:Individual
Prefix:
First Name:ALEESHA
Middle Name:BREANN
Last Name:FLEMING
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:637 S YOUNG ST
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-8531
Mailing Address - Country:US
Mailing Address - Phone:509-492-8538
Mailing Address - Fax:
Practice Address - Street 1:5399 W VAN GIESEN ST
Practice Address - Street 2:
Practice Address - City:WEST RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99353-9305
Practice Address - Country:US
Practice Address - Phone:509-492-8538
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-07
Last Update Date:2012-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60213740225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist