Provider Demographics
NPI:1083674816
Name:GULISH, MELANIE A (MSPT)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:A
Last Name:GULISH
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:MELANIE
Other - Middle Name:A
Other - Last Name:OTTO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSPT
Mailing Address - Street 1:PO BOX 731269
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98373-0060
Mailing Address - Country:US
Mailing Address - Phone:253-840-2313
Mailing Address - Fax:253-840-6340
Practice Address - Street 1:5605 100TH ST SW
Practice Address - Street 2:SUITE B
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-2710
Practice Address - Country:US
Practice Address - Phone:253-284-9800
Practice Address - Fax:253-284-9801
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00008189225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist