Provider Demographics
NPI:1215144704
Name:LEE, ALEXA J
Entity type:Individual
Prefix:
First Name:ALEXA
Middle Name:J
Last Name:LEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ALEXA
Other - Middle Name:J
Other - Last Name:HARPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:PO BOX 370
Mailing Address - Street 2:
Mailing Address - City:BELFAIR
Mailing Address - State:WA
Mailing Address - Zip Code:98528-0370
Mailing Address - Country:US
Mailing Address - Phone:360-536-0343
Mailing Address - Fax:360-275-9695
Practice Address - Street 1:1202 7TH ST
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98337-1251
Practice Address - Country:US
Practice Address - Phone:360-536-0343
Practice Address - Fax:360-275-9685
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2009-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00024600225700000X
FLMA47632225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist