Healthcare Provider Details

I. General information

NPI: 1205562113
Provider Name (Legal Business Name): ALEXANDRIA HEIM LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANDIE HEIM LMT

II. Dates (important events)

Enumeration Date: 07/25/2022
Last Update Date: 07/25/2022
Certification Date: 07/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

148 BURSIEL CIRCLE
GIRDWOOD AK
99587
US

IV. Provider business mailing address

PO BOX 1146
GIRDWOOD AK
99587-1146
US

V. Phone/Fax

Practice location:
  • Phone: 757-630-5204
  • Fax:
Mailing address:
  • Phone: 758-630-5204
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number173119
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: