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General NPI Number Information
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NPI Number | 1518658467
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Entity Type | Individual
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Provider Name | ALEC DIVALERIO
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Gender | Male
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Dates
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Enumeration Date | 05/19/2023
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Last Update Date | 09/11/2024
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Provider Practice Location Address
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Address Line | 1600 SLEATER KINNEY RD SE
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City | LACEY
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State | WA
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Zip | 98503-2500
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Country | US
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Telephone | 360-456-0111
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Fax |
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Provider Business Mailing Address
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Address Line | 1864 21ST AVE SE
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City | OLYMPIA
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State | WA
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Zip | 98501-8904
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Country | US
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Telephone | 214-244-7613
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 1376653
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License Number State | TX
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