1295116077 NPI number — ALISSA DENAE' MARKS MS, LAT, ATC

Table of content: ALISSA DENAE' MARKS MS, LAT, ATC (NPI 1295116077)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295116077 NPI number — ALISSA DENAE' MARKS MS, LAT, ATC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARKS
Provider First Name:
ALISSA
Provider Middle Name:
DENAE'
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MS, LAT, ATC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1295116077
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/14/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7005 TREE CROSSING PARKWAY
Provider Second Line Business Mailing Address:
APT 7005
Provider Business Mailing Address City Name:
HOOVER
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35244
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
337-459-2013
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
370 JOHN FRUGE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70589-4107
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-459-2013
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/17/2015

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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