Individual
MELONEE PEARL CROUSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
1845 E BROADWAY RD STE 116-6, TEMPE, AZ 85282-1633
(480) 770-6641
Mailing address
1845 E BROADWAY RD STE 116-6, TEMPE, AZ 85282-1633
(480) 770-6641
Taxonomy
Speciality
Code
Description
License number
State
172M00000X
Mechanotherapist
MT-09980
AZ
225700000X
Massage Therapist
Primary
MT-09980
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MT-09980
LMT
AZ
Enumeration date
05/27/2022
Last updated
05/27/2022
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