Provider Demographics
NPI:1821133463
Name:THRASH, MELISSA ANN (LMP)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANN
Last Name:THRASH
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:ANN
Other - Last Name:FERRUCCI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMP
Mailing Address - Street 1:12932 SE KENT KANGLEY RD
Mailing Address - Street 2:#438
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98030-7940
Mailing Address - Country:US
Mailing Address - Phone:425-392-1814
Mailing Address - Fax:425-392-1813
Practice Address - Street 1:23925 225TH WAY SE
Practice Address - Street 2:SUITE B
Practice Address - City:MAPLE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:98038-5233
Practice Address - Country:US
Practice Address - Phone:425-433-0760
Practice Address - Fax:425-433-0733
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2009-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00015957225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA262648284212OtherPREMERA BLUE CROSS
WA0182249OtherDEPT OF L&I
WA14178OtherAETNA INSURANCE
WA32011135812OtherUNIFORM MEDICAL INSURANCE