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General NPI Number Information
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NPI Number | 1770350100
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Entity Type | Individual
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Provider Name | MELANIE NIELSEN LMT
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Gender | Female
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Dates
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Enumeration Date | 12/06/2023
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Last Update Date | 12/06/2023
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Provider Practice Location Address
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Address Line | 2451 E BASELINE RD STE 100
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City | GILBERT
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State | AZ
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Zip | 85234-2467
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Country | US
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Telephone | 480-916-4757
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Fax | 480-603-4147
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Provider Business Mailing Address
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Address Line | 2451 E BASELINE RD STE 100
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City | GILBERT
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State | AZ
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Zip | 85234-2467
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Country | US
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Telephone | 480-916-4757
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Fax | 480-603-4147
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 28966
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License Number State | UT
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