Provider Demographics
NPI:1932077955
Name:LAVALAIS, MELANIE (LMT)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:LAVALAIS
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 1:1112 ELM ST SE STE E
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30014-2805
Mailing Address - Country:US
Mailing Address - Phone:678-849-8112
Mailing Address - Fax:
Practice Address - Street 1:1112 ELM ST SE STE E
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30014-2805
Practice Address - Country:US
Practice Address - Phone:678-849-8112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-29
Last Update Date:2025-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT012391225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist