Provider Demographics
NPI:1548549835
Name:VANTREASE, MELISSA (LMP)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:VANTREASE
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:PO BOX 10322
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98909-1322
Mailing Address - Country:US
Mailing Address - Phone:509-480-8001
Mailing Address - Fax:
Practice Address - Street 1:1508 S 36TH AVE
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-4859
Practice Address - Country:US
Practice Address - Phone:509-248-0301
Practice Address - Fax:509-248-0337
Is Sole Proprietor?:No
Enumeration Date:2011-08-04
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 00023285225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist