Provider Demographics
NPI:1851059554
Name:ALEXANDER, CARL (CMT)
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:
Last Name:ALEXANDER
Suffix:
Gender:M
Credentials:CMT
Other - Prefix:
Other - First Name:CARL
Other - Middle Name:ALEXANDER
Other - Last Name:SCHMIDL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:314 AVILA RD
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94402-2852
Mailing Address - Country:US
Mailing Address - Phone:415-244-5866
Mailing Address - Fax:
Practice Address - Street 1:1844 MARKET ST
Practice Address - Street 2:STUDIO #2
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94102-6283
Practice Address - Country:US
Practice Address - Phone:415-244-5866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-30
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60826225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist