Basic Information
| Provider Information | |||||||||
| NPI: | 1881659324 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GUERTIN | ||||||||
| FirstName: | MELINDA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1519 132ND ST SE | ||||||||
| Address2: | SUITE A | ||||||||
| City: | EVERETT | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982087203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4253300633 | ||||||||
| FaxNumber: | 4253389637 | ||||||||
| Practice Location | |||||||||
| Address1: | 5029 EVERGREEN WAY | ||||||||
| Address2: | |||||||||
| City: | EVERETT | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982032826 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4252521642 | ||||||||
| FaxNumber: | 4252581824 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/18/2006 | ||||||||
| LastUpdateDate: | 07/06/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225700000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Massage Therapist |
ID Information
| ID | Type | State | Issuer | Description | 8938155 | 01 | WA | L & I CRIME VICTIMS | OTHER | 911745305-98252-B011 | 01 | WA | TRICARE | OTHER | 0264722 | 01 | WA | DEPT OF L&I | OTHER | 3872GU | 01 | WA | REGENCE BLUE SHIELD | OTHER | 7912592 | 01 | WA | AETNA | OTHER | 0201982 | 01 | WA | DEPT. OF LABOR & INDUSTRY | OTHER | 5029GU | 01 | WA | REGENCE BLUE SHIELD | OTHER | 8896GU | 01 | WA | REGENCE BLUE SHIELD | OTHER |