1770888372 NPI number — ALEXANDRIA MOSHE-MCINTYRE MASSAGE PRACTITIONER

Table of content: ALEXANDRIA MOSHE-MCINTYRE MASSAGE PRACTITIONER (NPI 1770888372)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770888372 NPI number — ALEXANDRIA MOSHE-MCINTYRE MASSAGE PRACTITIONER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MOSHE-MCINTYRE
Provider First Name:
ALEXANDRIA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MASSAGE PRACTITIONER
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1770888372
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/13/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4240 OLD SEWARD HWY STE 12
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ANCHORAGE
Provider Business Mailing Address State Name:
AK
Provider Business Mailing Address Postal Code:
99503-6053
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
907-830-9614
Provider Business Mailing Address Fax Number:
907-344-7235

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4240 OLD SEWARD HIGHWAY, STE. 12
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ANCHORAGE
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99503
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-830-9614
Provider Business Practice Location Address Fax Number:
907-344-7235
Provider Enumeration Date:
01/13/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 173C00000X , with the licence number:  MP1959 , registered in the state of AK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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