Individual
KOURTKNIE ALEXIS AMILLIDREEM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT 3679
Contact information
Practice address
1222 OLD FANNIN RD STE D, BRANDON, MS 39047-8795
(601) 842-5559
Mailing address
1888 MAIN ST STE 477, MADISON, MS 39110-6337
(601) 842-5559
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
LMT3679
MS
Other
Enumeration date
10/09/2024
Last updated
10/10/2024
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