Provider Demographics
NPI:1295563773
Name:PRIESTELY, ALISSA TERESE (LMT)
Entity type:Individual
Prefix:
First Name:ALISSA
Middle Name:TERESE
Last Name:PRIESTELY
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 1:115 KINGSMILL RD
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27511-7241
Mailing Address - Country:US
Mailing Address - Phone:239-747-4967
Mailing Address - Fax:
Practice Address - Street 1:1148 EXECUTIVE CIR STE 3
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-4575
Practice Address - Country:US
Practice Address - Phone:919-857-5818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-25
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC19156225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist