Provider Demographics
NPI:1477206654
Name:SARUSAL, MELISSA JANE
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:JANE
Last Name:SARUSAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20401 34TH PL S APT M207
Mailing Address - Street 2:
Mailing Address - City:SEATAC
Mailing Address - State:WA
Mailing Address - Zip Code:98198-5872
Mailing Address - Country:US
Mailing Address - Phone:206-799-4303
Mailing Address - Fax:
Practice Address - Street 1:918 S HORTON ST STE 920
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98134-1949
Practice Address - Country:US
Practice Address - Phone:206-799-4303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-28
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60651964225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist