Provider Demographics
NPI:1770204422
Name:HARTMAN, ALEXA MARIE
Entity type:Individual
Prefix:
First Name:ALEXA
Middle Name:MARIE
Last Name:HARTMAN
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 1:428 SW HAYWORTH DR UNIT 301
Mailing Address - Street 2:
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98367-5019
Mailing Address - Country:US
Mailing Address - Phone:253-880-4364
Mailing Address - Fax:
Practice Address - Street 1:11430 51ST AVE
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98332-7897
Practice Address - Country:US
Practice Address - Phone:253-857-6500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-09
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA61319183225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist