Provider Demographics
NPI:1144527250
Name:RICHARDSON, ALYSSA LUANNA (LMT)
Entity type:Individual
Prefix:MISS
First Name:ALYSSA
Middle Name:LUANNA
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10500 SW GREENBURG RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-1406
Mailing Address - Country:US
Mailing Address - Phone:503-684-9698
Mailing Address - Fax:503-213-9698
Practice Address - Street 1:10500 SW GREENBURG RD
Practice Address - Street 2:SUITE 200
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-1406
Practice Address - Country:US
Practice Address - Phone:503-684-9698
Practice Address - Fax:503-213-9698
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-25
Last Update Date:2011-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR17961225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist