Provider Demographics
NPI:1356689384
Name:SAVERY, ALEXANDRA DEVON (LMP)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:DEVON
Last Name:SAVERY
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2004 FAIRVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98121-2704
Mailing Address - Country:US
Mailing Address - Phone:206-749-0169
Mailing Address - Fax:
Practice Address - Street 1:2004 FAIRVIEW AVE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98121-2704
Practice Address - Country:US
Practice Address - Phone:206-749-0169
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-25
Last Update Date:2013-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA 60324973225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist