Provider Demographics
NPI:1396894804
Name:ALEXANDER, ANNE G (PT)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:G
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1428 LORAINE ST
Mailing Address - Street 2:
Mailing Address - City:ENUMCLAW
Mailing Address - State:WA
Mailing Address - Zip Code:98022-2237
Mailing Address - Country:US
Mailing Address - Phone:360-825-0295
Mailing Address - Fax:360-825-7434
Practice Address - Street 1:1110 STEVENSON AVE
Practice Address - Street 2:
Practice Address - City:ENUMCLAW
Practice Address - State:WA
Practice Address - Zip Code:98022-2647
Practice Address - Country:US
Practice Address - Phone:360-825-7411
Practice Address - Fax:360-825-7434
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00000465174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8802071Medicare ID - Type Unspecified