Provider Demographics
NPI:1073348058
Name:ALLEN, ALYSHA SUMMER
Entity type:Individual
Prefix:
First Name:ALYSHA
Middle Name:SUMMER
Last Name:ALLEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ALYSHA
Other - Middle Name:SUMMER
Other - Last Name:FRAYSER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:181 W COMMERCE DR
Mailing Address - Street 2:
Mailing Address - City:HAYDEN
Mailing Address - State:ID
Mailing Address - Zip Code:83835-9221
Mailing Address - Country:US
Mailing Address - Phone:208-696-1330
Mailing Address - Fax:
Practice Address - Street 1:181 W COMMERCE DR
Practice Address - Street 2:
Practice Address - City:HAYDEN
Practice Address - State:ID
Practice Address - Zip Code:83835-9221
Practice Address - Country:US
Practice Address - Phone:208-696-1330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-07
Last Update Date:2024-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID7961361225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist