Provider Demographics
NPI:1871922716
Name:REANDO, MELINDA (PTA)
Entity type:Individual
Prefix:
First Name:MELINDA
Middle Name:
Last Name:REANDO
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3406 156TH ST NW
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98332-9257
Mailing Address - Country:US
Mailing Address - Phone:253-583-4415
Mailing Address - Fax:360-478-6246
Practice Address - Street 1:140 MARION AVE S
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98312-3639
Practice Address - Country:US
Practice Address - Phone:360-479-4747
Practice Address - Fax:360-478-6246
Is Sole Proprietor?:No
Enumeration Date:2013-11-01
Last Update Date:2013-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAP160279874225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant