Provider Demographics
NPI:1235503731
Name:DONAHOU, ALEX
Entity Type:Individual
Prefix:
First Name:ALEX
Middle Name:
Last Name:DONAHOU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15099 DEFIANCE DR SE
Mailing Address - Street 2:
Mailing Address - City:OLALLA
Mailing Address - State:WA
Mailing Address - Zip Code:98359-8513
Mailing Address - Country:US
Mailing Address - Phone:360-362-6563
Mailing Address - Fax:
Practice Address - Street 1:15099 DEFIANCE DR SE
Practice Address - Street 2:
Practice Address - City:OLALLA
Practice Address - State:WA
Practice Address - Zip Code:98359-8513
Practice Address - Country:US
Practice Address - Phone:360-362-6563
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-20
Last Update Date:2015-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60615526225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist