Provider Demographics
NPI:1689494569
Name:BRAITHWAITE, ALESHA (LMT)
Entity type:Individual
Prefix:
First Name:ALESHA
Middle Name:
Last Name:BRAITHWAITE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1312 RAINBOW CIR
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84040-2939
Mailing Address - Country:US
Mailing Address - Phone:801-695-7235
Mailing Address - Fax:
Practice Address - Street 1:1312 RAINBOW CIR
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84040-2939
Practice Address - Country:US
Practice Address - Phone:801-695-7235
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-15
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13436212-4701225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty