Provider Demographics
NPI:1700488194
Name:ALDE, ANTHONY HUGO (LMT)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:HUGO
Last Name:ALDE
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1210 PARKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WISCONSIN RAPIDS
Mailing Address - State:WI
Mailing Address - Zip Code:54494-5488
Mailing Address - Country:US
Mailing Address - Phone:715-424-4646
Mailing Address - Fax:
Practice Address - Street 1:1210 PARKWOOD DR
Practice Address - Street 2:
Practice Address - City:WISCONSIN RAPIDS
Practice Address - State:WI
Practice Address - Zip Code:54494-5488
Practice Address - Country:US
Practice Address - Phone:715-424-4646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-11
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15292-146225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist