Provider Demographics
NPI:1811913494
Name:IRVINE, MELINDA DAWN (PT)
Entity type:Individual
Prefix:MRS
First Name:MELINDA
Middle Name:DAWN
Last Name:IRVINE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MELINDA
Other - Middle Name:DAWN
Other - Last Name:VORIES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6825 BURDEN BLVD STE D
Mailing Address - Street 2:
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99301-5633
Mailing Address - Country:US
Mailing Address - Phone:509-545-1010
Mailing Address - Fax:509-545-1112
Practice Address - Street 1:6825 BURDEN BLVD STE D
Practice Address - Street 2:
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301-5633
Practice Address - Country:US
Practice Address - Phone:509-545-1010
Practice Address - Fax:509-545-1112
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2015-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00005994225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAB25317OtherMEDICARE PTAN
WA0151973OtherLABOR & INDUSTRIES
S11739Medicare UPIN
S11739Medicare UPIN
WA0151973OtherLABOR & INDUSTRIES