Provider Demographics
NPI:1205562113
Name:HEIM, ALEXANDRIA (LMT)
Entity type:Individual
Prefix:
First Name:ALEXANDRIA
Middle Name:
Last Name:HEIM
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:ANDIE
Other - Middle Name:
Other - Last Name:HEIM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:PO BOX 1146
Mailing Address - Street 2:
Mailing Address - City:GIRDWOOD
Mailing Address - State:AK
Mailing Address - Zip Code:99587-1146
Mailing Address - Country:US
Mailing Address - Phone:758-630-5204
Mailing Address - Fax:
Practice Address - Street 1:148 BURSIEL CIRCLE
Practice Address - Street 2:
Practice Address - City:GIRDWOOD
Practice Address - State:AK
Practice Address - Zip Code:99587
Practice Address - Country:US
Practice Address - Phone:757-630-5204
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-25
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK173119225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist