Provider Demographics
NPI:1538402268
Name:TOBOL, MELISSA ANNE (LMP)
Entity type:Individual
Prefix:MISS
First Name:MELISSA
Middle Name:ANNE
Last Name:TOBOL
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 1:12035 DES MOINES MEM DR S
Mailing Address - Street 2:#1
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98168-2275
Mailing Address - Country:US
Mailing Address - Phone:206-354-4540
Mailing Address - Fax:
Practice Address - Street 1:2201 SW 356TH ST
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98023-3033
Practice Address - Country:US
Practice Address - Phone:253-838-1441
Practice Address - Fax:253-838-4345
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-01
Last Update Date:2013-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60042686225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist