Healthcare Provider Details

I. General information

NPI: 1023947439
Provider Name (Legal Business Name): DALE GRAMM ALEXANDER MASSAGE THERAPIST
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2026
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2002 N LAKESIDE DR
LAKE WORTH BEACH FL
33460-6339
US

IV. Provider business mailing address

2002 N LAKESIDE DR
LAKE WORTH BEACH FL
33460-6339
US

V. Phone/Fax

Practice location:
  • Phone: 305-393-0929
  • Fax:
Mailing address:
  • Phone: 305-393-0929
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA3693
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: