Provider Demographics
NPI:1801386875
Name:DIGRAZIA, ALEXANDER NATHAN (LMT)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:NATHAN
Last Name:DIGRAZIA
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 1:656 CHARNELTON ST
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-2689
Mailing Address - Country:US
Mailing Address - Phone:541-653-8692
Mailing Address - Fax:541-653-8789
Practice Address - Street 1:656 CHARNELTON ST
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-2689
Practice Address - Country:US
Practice Address - Phone:541-653-8692
Practice Address - Fax:541-653-8789
Is Sole Proprietor?:No
Enumeration Date:2018-05-15
Last Update Date:2018-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR24296225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist