Healthcare Provider Details

I. General information

NPI: 1225388200
Provider Name (Legal Business Name): MELISA K ZALDIVAR MS, PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2012
Last Update Date: 09/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 4TH ST NE
AUBURN WA
98002-5020
US

IV. Provider business mailing address

502 4TH ST NE
AUBURN WA
98002-5020
US

V. Phone/Fax

Practice location:
  • Phone: 253-931-4927
  • Fax:
Mailing address:
  • Phone: 253-931-4927
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number5735
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: