Provider Demographics
NPI:1972158301
Name:GREENWOOD, ALISSA JEANETTE (CMT)
Entity Type:Individual
Prefix:
First Name:ALISSA
Middle Name:JEANETTE
Last Name:GREENWOOD
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:ALISSA
Other - Middle Name:JEANETTE
Other - Last Name:DANN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CMT
Mailing Address - Street 1:1876 WOODSAGE WAY
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404-7030
Mailing Address - Country:US
Mailing Address - Phone:707-328-4615
Mailing Address - Fax:
Practice Address - Street 1:1301 FARMERS LN STE 302
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405-6745
Practice Address - Country:US
Practice Address - Phone:707-536-1147
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-02
Last Update Date:2019-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25017225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist