Healthcare Provider Details

I. General information

NPI: 1831753623
Provider Name (Legal Business Name): MELINDA MICHELE COLLINS LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MELINDA MICHELE COLLINS MELINDA COLLINS LMT

II. Dates (important events)

Enumeration Date: 04/26/2019
Last Update Date: 04/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2322 D AVE NE
CEDAR RAPIDS IA
52402-4921
US

IV. Provider business mailing address

2322 D AVE NE
CEDAR RAPIDS IA
52402-4921
US

V. Phone/Fax

Practice location:
  • Phone: 319-321-1576
  • Fax:
Mailing address:
  • Phone: 319-321-1576
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number005798
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: