Provider Demographics
NPI:1669788188
Name:AVIS, ALICIA (LMP)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:AVIS
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 1:10722 63RD ST E
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98372-5842
Mailing Address - Country:US
Mailing Address - Phone:253-720-5682
Mailing Address - Fax:
Practice Address - Street 1:10612 CANYON RD E
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98373-4257
Practice Address - Country:US
Practice Address - Phone:253-302-4817
Practice Address - Fax:253-507-4381
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00023008225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist