=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326594078
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALEXANDER CAUDLE LMP LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/31/2016
-----------------------------------------------------
Last Update Date | 08/31/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3400 HARBOR AVE SW,
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98106
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 202-688-7960
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4720 25TH AVE SW
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98106-1316
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 202-688-7960
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER / MASSAGE THERAPIST
-----------------------------------------------------
Name | ALEXANDER L CAUDLE
-----------------------------------------------------
Credential | LMP
-----------------------------------------------------
Telephone | 202-688-7960
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | MA60178652
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------