Provider Demographics
NPI:1750569760
Name:EGGERT, ALISSA (LAC, LMT)
Entity type:Individual
Prefix:
First Name:ALISSA
Middle Name:
Last Name:EGGERT
Suffix:
Gender:F
Credentials:LAC, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7601 E TREASURE DR APT 1716
Mailing Address - Street 2:
Mailing Address - City:NORTH BAY VILLAGE
Mailing Address - State:FL
Mailing Address - Zip Code:33141-4366
Mailing Address - Country:US
Mailing Address - Phone:206-859-1691
Mailing Address - Fax:
Practice Address - Street 1:1441 BRICKELL AVE FL 4
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33131-3425
Practice Address - Country:US
Practice Address - Phone:305-676-2789
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-01
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA97728172M00000X
FLAP4513171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No172M00000XOther Service ProvidersMechanotherapist