Provider Demographics
NPI:1932606324
Name:PEDEN, ALEXA JEAN (LMT)
Entity Type:Individual
Prefix:
First Name:ALEXA
Middle Name:JEAN
Last Name:PEDEN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15827 11TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98155-6301
Mailing Address - Country:US
Mailing Address - Phone:425-466-7453
Mailing Address - Fax:425-466-7453
Practice Address - Street 1:15827 11TH AVE NE
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98155-6301
Practice Address - Country:US
Practice Address - Phone:425-466-7453
Practice Address - Fax:425-466-7453
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-11
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60842511225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist