Provider Demographics
NPI:1851718621
Name:MELLROTH, DANIELLE (LMP)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:MELLROTH
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1837 N 52ND ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-6111
Mailing Address - Country:US
Mailing Address - Phone:360-224-0023
Mailing Address - Fax:
Practice Address - Street 1:1100 BELLEVUE WAY NE
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-4280
Practice Address - Country:US
Practice Address - Phone:425-292-7888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-18
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60175880225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist