Provider Demographics
NPI:1073386694
Name:DALE, ALEXANDER CHRISTIAN (CMT)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:CHRISTIAN
Last Name:DALE
Suffix:
Gender:M
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2905 DAVID AVE APT 8
Mailing Address - Street 2:
Mailing Address - City:PACIFIC GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:93950-5121
Mailing Address - Country:US
Mailing Address - Phone:415-299-9023
Mailing Address - Fax:
Practice Address - Street 1:2905 DAVID AVE APT 8
Practice Address - Street 2:
Practice Address - City:PACIFIC GROVE
Practice Address - State:CA
Practice Address - Zip Code:93950-5121
Practice Address - Country:US
Practice Address - Phone:415-299-9023
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-06
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA68721225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist