Provider Demographics
NPI:1023715133
Name:DESROSIERS, ALLISON E (LMT)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:E
Last Name:DESROSIERS
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 1:1402 S JENTILLY LN UNIT 101
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85281-5716
Mailing Address - Country:US
Mailing Address - Phone:702-742-8997
Mailing Address - Fax:
Practice Address - Street 1:1402 S JENTILLY LN UNIT 101
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85281-5716
Practice Address - Country:US
Practice Address - Phone:702-742-8997
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-09
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT-17479225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist