Basic Information
| Provider Information | |||||||||
| NPI: | 1649560194 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CLARK | ||||||||
| FirstName: | ALANA | ||||||||
| MiddleName: | CHRISTINE | ||||||||
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| Credential: | LMP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 969 22ND AVE | ||||||||
| Address2: | APT B | ||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981224869 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2069543582 | ||||||||
| FaxNumber: | 2067449943 | ||||||||
| Practice Location | |||||||||
| Address1: | 1801 NW MARKET ST | ||||||||
| Address2: | SUITE 408 | ||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981073987 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2067842800 | ||||||||
| FaxNumber: | 2067845257 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/17/2011 | ||||||||
| LastUpdateDate: | 04/17/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225700000X | MA 60208081 | WA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Massage Therapist |
No ID Information.