Provider Demographics
NPI:1285884270
Name:MEYRICK, ALESSANDRA VALERIE (LMT)
Entity type:Individual
Prefix:
First Name:ALESSANDRA
Middle Name:VALERIE
Last Name:MEYRICK
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 82
Mailing Address - Street 2:
Mailing Address - City:ALVA
Mailing Address - State:FL
Mailing Address - Zip Code:33920-0082
Mailing Address - Country:US
Mailing Address - Phone:239-243-6621
Mailing Address - Fax:
Practice Address - Street 1:721 DESOTO AVE
Practice Address - Street 2:
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33972-7936
Practice Address - Country:US
Practice Address - Phone:239-243-6621
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-25
Last Update Date:2008-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 48485171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor