Provider Demographics
NPI:1780364547
Name:OLRICH, MELANIE MARY KINNAN (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:MELANIE
Middle Name:MARY KINNAN
Last Name:OLRICH
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:MELANIE
Other - Middle Name:MARY
Other - Last Name:KINNAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:25117 SW PARKWAY AVE STE D
Mailing Address - Street 2:
Mailing Address - City:WILSONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97070-9697
Mailing Address - Country:US
Mailing Address - Phone:971-364-0611
Mailing Address - Fax:971-364-0610
Practice Address - Street 1:25 SUNSHINE CT
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-6023
Practice Address - Country:US
Practice Address - Phone:970-385-4090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-18
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.0016977225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist