Provider Demographics
NPI:1629485644
Name:GRAVES, MELISSA CATHERINE (LMT)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:CATHERINE
Last Name:GRAVES
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 1:18730 33RD AVE W
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98037-4756
Mailing Address - Country:US
Mailing Address - Phone:425-774-8600
Mailing Address - Fax:
Practice Address - Street 1:18730 33RD AVE W
Practice Address - Street 2:SUITE 100
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98037-4756
Practice Address - Country:US
Practice Address - Phone:425-774-8600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-22
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT-11356225700000X
WAMA60473431225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist