Provider Demographics
NPI:1902182223
Name:WATSON, MELODY JEAN (PT)
Entity Type:Individual
Prefix:MRS
First Name:MELODY
Middle Name:JEAN
Last Name:WATSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:MELODY
Other - Middle Name:JEAN
Other - Last Name:BENEFIELD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1821 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98270-4329
Mailing Address - Country:US
Mailing Address - Phone:360-659-3926
Mailing Address - Fax:360-658-0555
Practice Address - Street 1:1821 GROVE ST
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:WA
Practice Address - Zip Code:98270-4329
Practice Address - Country:US
Practice Address - Phone:360-659-3926
Practice Address - Fax:360-658-0555
Is Sole Proprietor?:No
Enumeration Date:2011-11-01
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00004089225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist