Provider Demographics
NPI:1811256506
Name:FRIEDMAN, MELISSA
Entity type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:
Last Name:FRIEDMAN
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:PO BOX 3753
Mailing Address - Street 2:201 WEST COLORADO AVE, NUGGET BUILDING, SUITE 208
Mailing Address - City:TELLURIDE
Mailing Address - State:CO
Mailing Address - Zip Code:81435-3753
Mailing Address - Country:US
Mailing Address - Phone:970-708-0778
Mailing Address - Fax:
Practice Address - Street 1:201 WEST COLORADO AVE.
Practice Address - Street 2:NUGGET BUILDING, SUITE 208
Practice Address - City:TELLURIDE
Practice Address - State:CO
Practice Address - Zip Code:81435
Practice Address - Country:US
Practice Address - Phone:970-708-0778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-15
Last Update Date:2012-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO13245225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist