Provider Demographics
NPI:1225011182
Name:MELNICK, MARSHA ELLEN (PT)
Entity Type:Individual
Prefix:
First Name:MARSHA
Middle Name:ELLEN
Last Name:MELNICK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16083 SW UPPER BOONES FERRY RD
Mailing Address - Street 2:STE. 300
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97224-7736
Mailing Address - Country:US
Mailing Address - Phone:800-219-8835
Mailing Address - Fax:503-639-9699
Practice Address - Street 1:1114 GEORGIANA ST
Practice Address - Street 2:
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98362-4212
Practice Address - Country:US
Practice Address - Phone:360-452-6216
Practice Address - Fax:360-452-8765
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2014-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00008951225100000X
CA18562225100000X
MI5501004944225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1225011182Medicaid
WA7022296Medicaid
WAG8857577Medicare PIN
WA7022296Medicaid