Provider Demographics
NPI:1124476106
Name:REIS, ALYSSA KATHLEEN PERRY (NCBTMB MT, CLT)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:KATHLEEN PERRY
Last Name:REIS
Suffix:
Gender:F
Credentials:NCBTMB MT, CLT
Other - Prefix:
Other - First Name:ALYSSA
Other - Middle Name:KATHLEEN
Other - Last Name:PERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4028 DEBORAH DR
Mailing Address - Street 2:
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99801-9136
Mailing Address - Country:US
Mailing Address - Phone:907-723-9455
Mailing Address - Fax:
Practice Address - Street 1:5750 GLACIER HWY STE 12
Practice Address - Street 2:
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-7246
Practice Address - Country:US
Practice Address - Phone:907-723-9455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-31
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK101442174H00000X, 225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No174H00000XOther Service ProvidersHealth Educator