Provider Demographics
NPI:1326594078
Name:ALEXANDER CAUDLE LMP LLC
Entity type:Organization
Organization Name:ALEXANDER CAUDLE LMP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / MASSAGE THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:L
Authorized Official - Last Name:CAUDLE
Authorized Official - Suffix:
Authorized Official - Credentials:LMP
Authorized Official - Phone:202-688-7960
Mailing Address - Street 1:4720 25TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98106-1316
Mailing Address - Country:US
Mailing Address - Phone:202-688-7960
Mailing Address - Fax:
Practice Address - Street 1:3400 HARBOR AVE SW,
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98106
Practice Address - Country:US
Practice Address - Phone:202-688-7960
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-31
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60178652225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty