Provider Demographics
NPI:1144396714
Name:MYERS, MELANIE R (DPT)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:R
Last Name:MYERS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:MELANIE
Other - Middle Name:R
Other - Last Name:KUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:9135 SW BARNES RD STE 362
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-6683
Mailing Address - Country:US
Mailing Address - Phone:503-216-3125
Mailing Address - Fax:
Practice Address - Street 1:9135 SW BARNES RD STE 362
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225
Practice Address - Country:US
Practice Address - Phone:503-216-3125
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1934225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100507555Medicaid
NV100507555Medicaid
NVV36885Medicare PIN