Kourtknie Alexis Amillidreem, LMT 3679
Massage Therapist in Brandon, MS. Individual provider (NPI-1).
NPI number1013736628
StatusActive
Last updated in NPPESOct 10, 2024
Details
- NPI
- 1013736628
- Entity type
- Individual (NPI-1)
- Name
- Kourtknie Alexis Amillidreem
- Credential
- LMT 3679
- Sex
- Female
- Sole proprietor
- Yes
- Enumeration date
- Oct 9, 2024
- Certification date
- Oct 10, 2024
- Last updated
- Oct 10, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 225700000X | Massage Therapist | LMT3679 | MS | Yes |
Practice location
1222 Old Fannin Rd Ste DBrandon, MS 39047-8795
Phone 601-842-5559
Mailing address
1888 Main St Ste 477Madison, MS 39110-6337
Phone 601-842-5559
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