Provider Demographics
NPI:1639496599
Name:STRIDE, ALICE (CPO)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:
Last Name:STRIDE
Suffix:
Gender:F
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 44TH ST SE
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98203-2200
Mailing Address - Country:US
Mailing Address - Phone:425-339-2559
Mailing Address - Fax:425-339-1583
Practice Address - Street 1:1520 ROOSEVELT AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98273-2685
Practice Address - Country:US
Practice Address - Phone:360-416-6505
Practice Address - Fax:360-416-8241
Is Sole Proprietor?:No
Enumeration Date:2010-04-30
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOI00000116222Z00000X
WAPS00000117224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist