Provider Demographics
NPI:1972275873
Name:WEMYSS, ALEXANDRA (LMT)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:WEMYSS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 VAN BUREN ST
Mailing Address - Street 2:
Mailing Address - City:DIMONDALE
Mailing Address - State:MI
Mailing Address - Zip Code:48821-9640
Mailing Address - Country:US
Mailing Address - Phone:517-304-2570
Mailing Address - Fax:
Practice Address - Street 1:57424 MEGAN DR
Practice Address - Street 2:
Practice Address - City:WASHINGTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48094-3816
Practice Address - Country:US
Practice Address - Phone:586-255-7471
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-29
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
7501011158225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist