Provider Demographics
NPI:1245515030
Name:PEREZ, ALYSSIA MICHELLE (LMP)
Entity type:Individual
Prefix:
First Name:ALYSSIA
Middle Name:MICHELLE
Last Name:PEREZ
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 1:4303 BRIDGEPORT WAY W STE 3
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY PL
Mailing Address - State:WA
Mailing Address - Zip Code:98466-4334
Mailing Address - Country:US
Mailing Address - Phone:253-271-4424
Mailing Address - Fax:
Practice Address - Street 1:4303 BRIDGEPORT WAY W STE 3
Practice Address - Street 2:
Practice Address - City:UNIVERSITY PL
Practice Address - State:WA
Practice Address - Zip Code:98466-4334
Practice Address - Country:US
Practice Address - Phone:253-271-4424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-12
Last Update Date:2022-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60240999225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist