Provider Demographics
NPI:1184765448
Name:MICHAELS, MELANIE BRITT (MPT)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:BRITT
Last Name:MICHAELS
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20201 NEW ENGLAND DR
Mailing Address - Street 2:
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-7116
Mailing Address - Country:US
Mailing Address - Phone:907-622-1975
Mailing Address - Fax:
Practice Address - Street 1:10421 VFW RD
Practice Address - Street 2:SUITE 103
Practice Address - City:EAGLE RIVER
Practice Address - State:AK
Practice Address - Zip Code:99577-8032
Practice Address - Country:US
Practice Address - Phone:907-350-3657
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1653225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKAK 1653OtherSTATE LICENSE #