MEDICARE: MS. MELISSA A FRIESE LMP

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	225700000X	Massage Therapist	MA00018124	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2154LO	OTHER	WA	REGENCE BS
2	194134	OTHER	WA	DEPT OF L&I
3	8904484	OTHER	WA	CRIME VICTIMS

General Provider Information

NPI Number	:	1881686467
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MELISSA A FRIESE LMP

Provider Business Mailing Address
First Line	:	PO BOX 731269
Second Line	:
City	:	PUYALLUP
State	:	WA
Zip	:	98373-0060
Country	:	US
Telephone Number	:	253-840-2313
Fax Number	:	253-840-6340

Provider Business Practice Location Address
First Line	:	11019 CANYON RD E
Second Line	:
City	:	PUYALLUP
State	:	WA
Zip	:	98373-3001
Country	:	US
Telephone Number	:	253-286-3600
Fax Number	:	253-286-3444

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

Provider Enumeration Date	:	08/18/2005
Last Update Date	:	07/08/2007

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