Provider Demographics
NPI:1275323347
Name:BENNETT, MELISSA ANNE (LMT)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANNE
Last Name:BENNETT
Suffix:
Gender:
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17498 BETTINA AVE
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79938-8721
Mailing Address - Country:US
Mailing Address - Phone:928-358-8604
Mailing Address - Fax:
Practice Address - Street 1:3500 LEE BLVD STE D
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-1413
Practice Address - Country:US
Practice Address - Phone:915-319-3308
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-10
Last Update Date:2025-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT145485225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist