Healthcare Provider Details

I. General information

NPI: 1831237486
Provider Name (Legal Business Name): MELODIE MAE MATTSON-BELL MPT,OCS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 11/25/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5930 ADOBE RD
TWENTYNINE PALMS CA
92277-2356
US

IV. Provider business mailing address

8260 N GRANITE OAKS DR
PRESCOTT AZ
86305-8767
US

V. Phone/Fax

Practice location:
  • Phone: 760-367-1743
  • Fax: 760-367-1083
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT10149
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: