Provider Demographics
NPI:1881686467
Name:FRIESE, MELISSA A (LMP)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:A
Last Name:FRIESE
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:MS
Other - First Name:MELISSA
Other - Middle Name:A
Other - Last Name:LOONEY, FINFROCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMP
Mailing Address - Street 1:PO BOX 731269
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98373-0060
Mailing Address - Country:US
Mailing Address - Phone:253-840-2313
Mailing Address - Fax:253-840-6340
Practice Address - Street 1:11019 CANYON RD E
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98373-3001
Practice Address - Country:US
Practice Address - Phone:253-286-3600
Practice Address - Fax:253-286-3444
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00018124225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2154LOOtherREGENCE BS
WA194134OtherDEPT OF L&I
WA8904484OtherCRIME VICTIMS