MEDICARE: MRS. MELINDA DAWN IRVINE PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT00005994	WA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AB25317	OTHER	WA	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	0151973	OTHER	WA	LABOR & INDUSTRIES

General Provider Information

NPI Number	:	1811913494
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MELINDA DAWN IRVINE PT

Provider Business Mailing Address
First Line	:	6825 BURDEN BLVD STE D
Second Line	:
City	:	PASCO
State	:	WA
Zip	:	99301-5633
Country	:	US
Telephone Number	:	509-545-1010
Fax Number	:	509-545-1112

Provider Business Practice Location Address
First Line	:	6825 BURDEN BLVD STE D
Second Line	:
City	:	PASCO
State	:	WA
Zip	:	99301-5633
Country	:	US
Telephone Number	:	509-545-1010
Fax Number	:	509-545-1112

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/15/2006
Last Update Date	:	07/31/2015

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