=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669619391
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KEVIN JOHN MCALERNEY BS, CMT, NCBTMB
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/16/2009
-----------------------------------------------------
Last Update Date | 08/08/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 770 11TH STREET LOST COAST HEALING ARTS
-----------------------------------------------------
City | ARCATA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95521
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 707-633-4991
-----------------------------------------------------
Fax | 224-365-3981
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1080 8TH ST #16
-----------------------------------------------------
City | ARCATA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95521-6167
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 707-633-4991
-----------------------------------------------------
Fax | 224-365-3981
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | 23713
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------