Provider Demographics
NPI:1063220218
Name:CHURAPE, ALYSA A
Entity type:Individual
Prefix:
First Name:ALYSA
Middle Name:A
Last Name:CHURAPE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ALYSA
Other - Middle Name:A
Other - Last Name:CHURAPE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA 61616873
Mailing Address - Street 1:811 NE 112TH AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98684-5115
Mailing Address - Country:US
Mailing Address - Phone:360-892-2226
Mailing Address - Fax:
Practice Address - Street 1:811 NE 112TH AVE STE 101
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-5115
Practice Address - Country:US
Practice Address - Phone:360-892-2226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-19
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61616873225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist