Provider Demographics
NPI:1740068527
Name:MENLE, ALYSSA GABRIELLE (LMT)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:GABRIELLE
Last Name:MENLE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:ALYSSA
Other - Middle Name:GABRIELLE
Other - Last Name:MENLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14706 SW BRICKYARD DR
Mailing Address - Street 2:
Mailing Address - City:SHERWOOD
Mailing Address - State:OR
Mailing Address - Zip Code:97140-9834
Mailing Address - Country:US
Mailing Address - Phone:530-921-4044
Mailing Address - Fax:
Practice Address - Street 1:22021 SW SHERWOOD BLVD
Practice Address - Street 2:
Practice Address - City:SHERWOOD
Practice Address - State:OR
Practice Address - Zip Code:97140-9327
Practice Address - Country:US
Practice Address - Phone:503-625-2290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-21
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR25981225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist