Provider Demographics
NPI:1790904118
Name:SARGENT, MELANIE YVONNE (LMT)
Entity Type:Individual
Prefix:MS
First Name:MELANIE
Middle Name:YVONNE
Last Name:SARGENT
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 1:1818 W FRANCIS AVE
Mailing Address - Street 2:SUITE 158
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99205-6834
Mailing Address - Country:US
Mailing Address - Phone:509-324-8155
Mailing Address - Fax:509-324-8155
Practice Address - Street 1:6815 N F ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208-4667
Practice Address - Country:US
Practice Address - Phone:509-324-8155
Practice Address - Fax:509-324-8155
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 10707171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA116945OtherLABOR & INDUSTRIES