Provider Demographics
NPI:1821436528
Name:WATSON, MELISSA DENISE (MSPT)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:DENISE
Last Name:WATSON
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3901 KERN WAY
Mailing Address - Street 2:STE 102
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-7804
Mailing Address - Country:US
Mailing Address - Phone:509-895-7449
Mailing Address - Fax:509-895-7452
Practice Address - Street 1:3901 KERN WAY
Practice Address - Street 2:SUITE 102
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-7804
Practice Address - Country:US
Practice Address - Phone:509-895-7449
Practice Address - Fax:509-895-7452
Is Sole Proprietor?:No
Enumeration Date:2013-06-05
Last Update Date:2019-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00009543225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA313034OtherDEPARTMENT OF LABOR AND INDUSTRIES
WA313034OtherDEPARTMENT OF LABOR AND INDUSTRIES