Doctor Name: | ALYSSA NANETTE CLARK |
NPI Number: | 1902233083 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | L.M.T. |
License Number: | KY-4831 |
Business Practice Address: | 140 N 4th St East Tower 17th Floor Louisville, KY - 402024227 |
Business Phone Number: | 5025877644 |
Business Fax Number: | |
Mailing Address: | 1101 Tallow Ln, LOUISVILLE |
State: | KY |
Postal Code: | 402145553 |
Phone Number: | 8127863169 |
Fax Number: | |
NPI Enumeration Date: | 10/03/2013 |
NPI Last Update Date: | 10/03/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225700000X |
License Number: | KY-4831 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | KY |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Massage Therapist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual trained in the manipulation of tissues (as by rubbing, stroking, kneading, or tapping) with the hand or an instrument for remedial or hygienic purposes. |