Healthcare Provider Details

I. General information

NPI: 1164868600
Provider Name (Legal Business Name): ALEXANDRIA GAGE LMP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2013
Last Update Date: 05/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9724 N WALL ST
SPOKANE WA
99218-2250
US

IV. Provider business mailing address

9724 N WALL ST
SPOKANE WA
99218-2250
US

V. Phone/Fax

Practice location:
  • Phone: 509-340-3303
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA60291289
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: