Provider Demographics
NPI:1245582949
Name:EVANS, MELISSA TARBUCK (DPT)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:TARBUCK
Last Name:EVANS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:POPPINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1560 140TH AVE NE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-4571
Mailing Address - Country:US
Mailing Address - Phone:425-746-2475
Mailing Address - Fax:425-746-2471
Practice Address - Street 1:1560 140TH AVE NE
Practice Address - Street 2:SUITE 100
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-4571
Practice Address - Country:US
Practice Address - Phone:425-746-2475
Practice Address - Fax:425-745-2471
Is Sole Proprietor?:No
Enumeration Date:2012-10-05
Last Update Date:2014-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60291178225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8914387Medicare PIN