Provider Demographics
NPI:1790148567
Name:BRAY, MELANIE (LMT)
Entity Type:Individual
Prefix:MRS
First Name:MELANIE
Middle Name:
Last Name:BRAY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MS
Other - First Name:MELANIE
Other - Middle Name:
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:1080 PICKERING DR
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99709-5767
Mailing Address - Country:US
Mailing Address - Phone:907-388-8514
Mailing Address - Fax:
Practice Address - Street 1:600 UNIVERSITY AVE STE 3D
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99709-3651
Practice Address - Country:US
Practice Address - Phone:907-388-8514
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-30
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK101960225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist