Provider Demographics
NPI:1326345927
Name:WALKER, MELINDA DAWN (LMT)
Entity Type:Individual
Prefix:MISS
First Name:MELINDA
Middle Name:DAWN
Last Name:WALKER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1910 LUCILLE AVE
Mailing Address - Street 2:SUITE #3
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86401-4693
Mailing Address - Country:US
Mailing Address - Phone:928-692-5999
Mailing Address - Fax:928-718-9444
Practice Address - Street 1:1910 LUCILLE AVE
Practice Address - Street 2:SUITE #3
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86401-4693
Practice Address - Country:US
Practice Address - Phone:928-692-5999
Practice Address - Fax:928-718-9444
Is Sole Proprietor?:No
Enumeration Date:2011-02-16
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
173C00000X
AZMT-13653225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No173C00000XOther Service ProvidersReflexologist