Provider Demographics
NPI:1265898993
Name:FLETCHER, ALEXANDRA PAIGE (LMT)
Entity type:Individual
Prefix:MISS
First Name:ALEXANDRA
Middle Name:PAIGE
Last Name:FLETCHER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12039 SE 31ST PL APT 10
Mailing Address - Street 2:
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97222-6871
Mailing Address - Country:US
Mailing Address - Phone:503-887-7192
Mailing Address - Fax:
Practice Address - Street 1:233 E COLUMBIA RIVER HWY
Practice Address - Street 2:
Practice Address - City:TROUTDALE
Practice Address - State:OR
Practice Address - Zip Code:97060-2078
Practice Address - Country:US
Practice Address - Phone:503-491-9266
Practice Address - Fax:503-491-0547
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-11
Last Update Date:2016-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR21787225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist