Provider Demographics
NPI:1609116482
Name:PADILLA, MELISSA YLEANA (LMT)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:YLEANA
Last Name:PADILLA
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26119 14TH PL S
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:WA
Mailing Address - Zip Code:98198-9119
Mailing Address - Country:US
Mailing Address - Phone:408-410-4633
Mailing Address - Fax:253-874-2104
Practice Address - Street 1:26119 14TH PL S
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:WA
Practice Address - Zip Code:98198-9119
Practice Address - Country:US
Practice Address - Phone:408-410-4633
Practice Address - Fax:253-874-2104
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-15
Last Update Date:2019-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60333860225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist