Provider Demographics
NPI:1356067540
Name:HERNING, ALLYSSA ANN (CMT)
Entity type:Individual
Prefix:
First Name:ALLYSSA
Middle Name:ANN
Last Name:HERNING
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 BUTLER AVE E
Mailing Address - Street 2:
Mailing Address - City:WEST ST PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55118-1501
Mailing Address - Country:US
Mailing Address - Phone:651-457-8646
Mailing Address - Fax:
Practice Address - Street 1:130 BUTLER AVE E
Practice Address - Street 2:
Practice Address - City:WEST ST PAUL
Practice Address - State:MN
Practice Address - Zip Code:55118-1501
Practice Address - Country:US
Practice Address - Phone:651-457-8646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-18
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist