Provider Demographics
NPI:1730397746
Name:ELBENNANE, MELYNDA B (PTA)
Entity type:Individual
Prefix:
First Name:MELYNDA
Middle Name:B
Last Name:ELBENNANE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:MELYNDA
Other - Middle Name:B
Other - Last Name:MARTEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:17641 156TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98058-9011
Mailing Address - Country:US
Mailing Address - Phone:206-898-1857
Mailing Address - Fax:
Practice Address - Street 1:200 ANDOVER PARK E
Practice Address - Street 2:SUITE 6
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98188-2938
Practice Address - Country:US
Practice Address - Phone:206-575-3182
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2010-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist