Provider Demographics
NPI:1578509600
Name:MELL, DAVID B (PT)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:B
Last Name:MELL
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1418 E 37TH AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99203-4102
Mailing Address - Country:US
Mailing Address - Phone:509-747-2279
Mailing Address - Fax:
Practice Address - Street 1:VA MEDICAL CENTER
Practice Address - Street 2:4815 NORTH ASSEMBLY STREET
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99205-6197
Practice Address - Country:US
Practice Address - Phone:509-434-7018
Practice Address - Fax:509-434-7150
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA3255225100000X
OR1433225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist