Provider Demographics
NPI:1851744585
Name:RIVERA, MELISA DAWN (LMT)
Entity Type:Individual
Prefix:MRS
First Name:MELISA
Middle Name:DAWN
Last Name:RIVERA
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 1:1209 MEADE AVE
Mailing Address - Street 2:
Mailing Address - City:PROSSER
Mailing Address - State:WA
Mailing Address - Zip Code:99350-1423
Mailing Address - Country:US
Mailing Address - Phone:509-786-3637
Mailing Address - Fax:509-786-7385
Practice Address - Street 1:203 N DENNIS ST STE E
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-3103
Practice Address - Country:US
Practice Address - Phone:509-531-4282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-18
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60545357225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist