Provider Demographics
NPI:1285990218
Name:BARNETT, ALASSA O (LMT)
Entity type:Individual
Prefix:
First Name:ALASSA
Middle Name:O
Last Name:BARNETT
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 1:5500 HARBOUR LAKE DR
Mailing Address - Street 2:APT E9
Mailing Address - City:GOOSE CREEK
Mailing Address - State:SC
Mailing Address - Zip Code:29445-5936
Mailing Address - Country:US
Mailing Address - Phone:843-270-0444
Mailing Address - Fax:
Practice Address - Street 1:5500 HARBOUR LAKE DR
Practice Address - Street 2:APT E9
Practice Address - City:GOOSE CREEK
Practice Address - State:SC
Practice Address - Zip Code:29445-5936
Practice Address - Country:US
Practice Address - Phone:843-270-0444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-04
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6244225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist