Provider Demographics
NPI:1235930900
Name:ALDRIDGE, LAEISHA (LMT)
Entity type:Individual
Prefix:
First Name:LAEISHA
Middle Name:
Last Name:ALDRIDGE
Suffix:
Gender:
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:732 N 38TH ST
Mailing Address - Street 2:
Mailing Address - City:EAST SAINT LOUIS
Mailing Address - State:IL
Mailing Address - Zip Code:62205-2108
Mailing Address - Country:US
Mailing Address - Phone:314-898-5571
Mailing Address - Fax:
Practice Address - Street 1:4717 W MAIN ST STE 1A
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62226-5296
Practice Address - Country:US
Practice Address - Phone:618-720-0016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-20
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL22702210225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist