Provider Demographics
NPI:1831753623
Name:COLLINS, MELINDA MICHELE (LMT)
Entity type:Individual
Prefix:
First Name:MELINDA
Middle Name:MICHELE
Last Name:COLLINS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:MELINDA
Other - Middle Name:MICHELE
Other - Last Name:COLLINS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MELINDA COLLINS LMT
Mailing Address - Street 1:2322 D AVE NE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-4921
Mailing Address - Country:US
Mailing Address - Phone:319-321-1576
Mailing Address - Fax:
Practice Address - Street 1:2322 D AVE NE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-4921
Practice Address - Country:US
Practice Address - Phone:319-321-1576
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-26
Last Update Date:2019-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA005798225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA775ZZ6780OtherDRIVER LICENSE