Provider Demographics
NPI:1235394404
Name:MCINTOSH, ALVIN W (LMT)
Entity Type:Individual
Prefix:MR
First Name:ALVIN
Middle Name:W
Last Name:MCINTOSH
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:162 CAVALIER ST
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32909-1173
Mailing Address - Country:US
Mailing Address - Phone:321-652-2751
Mailing Address - Fax:
Practice Address - Street 1:1954 DAIRY RD
Practice Address - Street 2:
Practice Address - City:W MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32904-4045
Practice Address - Country:US
Practice Address - Phone:321-956-7777
Practice Address - Fax:321-956-2977
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-27
Last Update Date:2008-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA50696225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist