Provider Demographics
NPI:1831237486
Name:MATTSON-BELL, MELODIE MAE (MPT,OCS)
Entity type:Individual
Prefix:
First Name:MELODIE
Middle Name:MAE
Last Name:MATTSON-BELL
Suffix:
Gender:F
Credentials:MPT,OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8260 N GRANITE OAKS DR
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86305-8767
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5930 ADOBE RD
Practice Address - Street 2:
Practice Address - City:TWENTYNINE PALMS
Practice Address - State:CA
Practice Address - Zip Code:92277-2356
Practice Address - Country:US
Practice Address - Phone:760-367-1743
Practice Address - Fax:760-367-1083
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2007-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT101492251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PT101490OtherBLUE SHIELD
CAPT0101490Medicaid
CA144792OtherWA. STATE DEPT OF LABOR
CA1930576OtherFIRST HEALTH-CCN
CA0PT101490OtherBLUE SHIELD