Provider Demographics
NPI:1407240948
Name:SMITH, MELINDA (LMT)
Entity Type:Individual
Prefix:MRS
First Name:MELINDA
Middle Name:
Last Name:SMITH
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 1:587 ORIOLE RD
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:LA
Mailing Address - Zip Code:70559-1804
Mailing Address - Country:US
Mailing Address - Phone:337-788-0461
Mailing Address - Fax:337-788-0462
Practice Address - Street 1:587 ORIOLE RD
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:LA
Practice Address - Zip Code:70559-1804
Practice Address - Country:US
Practice Address - Phone:337-788-0461
Practice Address - Fax:337-788-0462
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-23
Last Update Date:2015-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALA7907225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist