Provider Demographics
NPI:1912138868
Name:ATHWAL, MELANIE KAMIULANI (LMP)
Entity Type:Individual
Prefix:MRS
First Name:MELANIE
Middle Name:KAMIULANI
Last Name:ATHWAL
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6427 VIEW RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98407-1117
Mailing Address - Country:US
Mailing Address - Phone:253-383-1949
Mailing Address - Fax:
Practice Address - Street 1:6427 VIEW RIDGE DR
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98407-1117
Practice Address - Country:US
Practice Address - Phone:253-383-1949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-27
Last Update Date:2009-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA16407172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist