Provider Demographics
NPI:1881908341
Name:MCALLASTER, ALEXANDREA S (LMT, CHTP)
Entity type:Individual
Prefix:
First Name:ALEXANDREA
Middle Name:S
Last Name:MCALLASTER
Suffix:
Gender:F
Credentials:LMT, CHTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 BEAL PKWY NW
Mailing Address - Street 2:SUITE A-1
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32548-4824
Mailing Address - Country:US
Mailing Address - Phone:850-582-2285
Mailing Address - Fax:
Practice Address - Street 1:90 BEAL PKWY NW
Practice Address - Street 2:SUITE A-1
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32548-4824
Practice Address - Country:US
Practice Address - Phone:850-582-2285
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-27
Last Update Date:2011-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 59372225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist