Provider Demographics
NPI:1093403735
Name:KANOUFF, MELISSA MAE (LMT)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:MAE
Last Name:KANOUFF
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 1:107 CEZANNE DR
Mailing Address - Street 2:
Mailing Address - City:RAYNE
Mailing Address - State:LA
Mailing Address - Zip Code:70578-2744
Mailing Address - Country:US
Mailing Address - Phone:412-289-9773
Mailing Address - Fax:
Practice Address - Street 1:107 CEZANNE DR
Practice Address - Street 2:
Practice Address - City:RAYNE
Practice Address - State:LA
Practice Address - Zip Code:70578-2744
Practice Address - Country:US
Practice Address - Phone:412-289-9773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-01
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALA9510225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty