Provider Demographics
NPI:1972160653
Name:PEREZ, ALEJANDRA (LMT)
Entity type:Individual
Prefix:
First Name:ALEJANDRA
Middle Name:
Last Name:PEREZ
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 1:995 HIGH GRADE WAY
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99712-2017
Mailing Address - Country:US
Mailing Address - Phone:907-799-1572
Mailing Address - Fax:907-759-7202
Practice Address - Street 1:815 2ND AVE STE 115
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-4469
Practice Address - Country:US
Practice Address - Phone:907-799-1572
Practice Address - Fax:907-759-7202
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-28
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK142217225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist