Provider Demographics
NPI:1225365828
Name:POWERS, MELODEE M (LMT)
Entity Type:Individual
Prefix:
First Name:MELODEE
Middle Name:M
Last Name:POWERS
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 1:2501 NIGHTSHADE DR
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-4052
Mailing Address - Country:US
Mailing Address - Phone:512-567-6121
Mailing Address - Fax:
Practice Address - Street 1:2501 NIGHTSHADE DR
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-4052
Practice Address - Country:US
Practice Address - Phone:512-567-6121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-03
Last Update Date:2009-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT042591225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist