Provider Demographics
NPI:1669619391
Name:MCALERNEY, KEVIN JOHN (BS, CMT, NCBTMB)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:JOHN
Last Name:MCALERNEY
Suffix:
Gender:M
Credentials:BS, CMT, NCBTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1080 8TH ST
Mailing Address - Street 2:#16
Mailing Address - City:ARCATA
Mailing Address - State:CA
Mailing Address - Zip Code:95521-6167
Mailing Address - Country:US
Mailing Address - Phone:707-633-4991
Mailing Address - Fax:224-365-3981
Practice Address - Street 1:770 11TH STREET
Practice Address - Street 2:LOST COAST HEALING ARTS
Practice Address - City:ARCATA
Practice Address - State:CA
Practice Address - Zip Code:95521
Practice Address - Country:US
Practice Address - Phone:707-633-4991
Practice Address - Fax:224-365-3981
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-16
Last Update Date:2011-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23713225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist