NPI 1013736628 · live from the CMS NPI Registry
Kourtknie Alexis Amillidreem, LMT 3679
Massage Therapist in Brandon, MS. National Provider Identifier 1013736628, active.
NPI record
| NPI | 1013736628 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Massage Therapist 225700000X |
| Practice location | 1222 Old Fannin Rd Ste D, Brandon, MS 39047 |
| Practice phone | 601-842-5559 |
| Mailing address | 1888 Main St Ste 477, Madison, MS 39110 |
| Enumerated | October 9, 2024 |
| Last updated | October 10, 2024 |
| Sole proprietor | Yes |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Massage Therapist primary | 225700000X | LMT3679 (MS) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.