Provider Demographics
NPI:1275365926
Name:ROEHS, ALISON LESLIE (LAC, LMT)
Entity type:Individual
Prefix:
First Name:ALISON
Middle Name:LESLIE
Last Name:ROEHS
Suffix:
Gender:X
Credentials:LAC, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:191 NORMAN AVE APT 4B
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11222-3529
Mailing Address - Country:US
Mailing Address - Phone:503-318-2909
Mailing Address - Fax:
Practice Address - Street 1:169 WYTHE AVE APT 103
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11249-3102
Practice Address - Country:US
Practice Address - Phone:347-377-2175
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-19
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033089-01225700000X
NY007198-01171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist