Provider Demographics
NPI:1447429543
Name:PEREZ, MELISSA FERN (LMP)
Entity Type:Individual
Prefix:MISS
First Name:MELISSA
Middle Name:FERN
Last Name:PEREZ
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2445 4TH AVE S
Mailing Address - Street 2:SUITE 112
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98134-1939
Mailing Address - Country:US
Mailing Address - Phone:206-467-7202
Mailing Address - Fax:206-622-0616
Practice Address - Street 1:2445 4TH AVE S
Practice Address - Street 2:SUITE 112
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98134-1939
Practice Address - Country:US
Practice Address - Phone:206-467-7202
Practice Address - Fax:206-622-0616
Is Sole Proprietor?:No
Enumeration Date:2008-02-22
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00024245225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist