Provider Demographics
NPI:1760604987
Name:ALPINE THERAPEUTIC MASSAGE
Entity Type:Organization
Organization Name:ALPINE THERAPEUTIC MASSAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:PHOENIX
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:ALEXANDER
Authorized Official - Suffix:
Authorized Official - Credentials:LMP
Authorized Official - Phone:253-838-3336
Mailing Address - Street 1:36511 32ND AVE S
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98001-9388
Mailing Address - Country:US
Mailing Address - Phone:253-838-3336
Mailing Address - Fax:253-838-1435
Practice Address - Street 1:36511 32ND AVE S
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98001-9388
Practice Address - Country:US
Practice Address - Phone:253-838-3336
Practice Address - Fax:253-838-1435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2009-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA250979OtherLABOR & INDUSTRIES