NPI 1013736628

Kourtknie Alexis Amillidreem, LMT

Practitioner Massage Therapist Brandon, MS

Practice location

Address: 1222 Old Fannin Rd STE D, Brandon, MS 39047-8795
Phone: (601) 842-5559
Mailing address: 1888 Main St STE 477, Madison, MS 39110-6337

Registered specialties

Massage Therapist Primary

Respiratory, Developmental, Rehabilitative and Restorative Service Providers Taxonomy 225700000X Licence LMT3679 (MS)

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Registry record

NPI: 1013736628
Entity type: Individual
Sex (as registered): Female
NPI issued: 9 Oct 2024
Record last updated: 10 Oct 2024

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.