Individual
MRS. MELINDA ELISE SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
L.M.T. , M.M.P
Contact information
Practice address
5812 MAPLECREST RD, FORT WAYNE, IN 46835-3840
(260) 969-7977
(260) 969-6590
Mailing address
4821 FOXGROVE AVE, FORT WAYNE, IN 46818-2029
(260) 246-9963
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MT209000676
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MT209000676
MASSAGE THERAPY LICENSE NUMBER
IN
Enumeration date
09/27/2014
Last updated
09/27/2014
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