Provider Demographics
NPI:1881659324
Name:GUERTIN, MELINDA
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:
Last Name:GUERTIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1519 132ND ST SE
Mailing Address - Street 2:SUITE A
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-7203
Mailing Address - Country:US
Mailing Address - Phone:425-330-0633
Mailing Address - Fax:425-338-9637
Practice Address - Street 1:5029 EVERGREEN WAY
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98203-2826
Practice Address - Country:US
Practice Address - Phone:425-252-1642
Practice Address - Fax:425-258-1824
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8938155OtherL & I CRIME VICTIMS
WA911745305-98252-B011OtherTRICARE
WA0264722OtherDEPT OF L&I
WA3872GUOtherREGENCE BLUE SHIELD
WA7912592OtherAETNA
WA0201982OtherDEPT. OF LABOR & INDUSTRY
WA5029GUOtherREGENCE BLUE SHIELD
WA8896GUOtherREGENCE BLUE SHIELD
WA3872GUOtherREGENCE BLUE SHIELD