Provider Demographics
NPI:1396304226
Name:JOSEPHS, ALEXANDRA MAE CATHERINE
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:MAE CATHERINE
Last Name:JOSEPHS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2938 LIMITED LN NW STE D
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-6501
Mailing Address - Country:US
Mailing Address - Phone:360-866-8940
Mailing Address - Fax:360-866-8943
Practice Address - Street 1:2938 LIMITED LN NW STE D
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-6501
Practice Address - Country:US
Practice Address - Phone:360-866-8940
Practice Address - Fax:360-866-8943
Is Sole Proprietor?:No
Enumeration Date:2019-06-13
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60517337225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist