Provider Demographics
NPI:1538686183
Name:LARSEN, MELISSA MURIEL (LMT)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:MURIEL
Last Name:LARSEN
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 1:4635 VENDUE RANGE DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27604-5079
Mailing Address - Country:US
Mailing Address - Phone:919-264-1652
Mailing Address - Fax:
Practice Address - Street 1:216 E CHATHAM ST
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-3499
Practice Address - Country:US
Practice Address - Phone:919-466-9494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-24
Last Update Date:2017-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13080225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist