Provider Demographics
NPI:1053359521
Name:APODACA, MELINDA G (LMT)
Entity type:Individual
Prefix:
First Name:MELINDA
Middle Name:G
Last Name:APODACA
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:MELINDA
Other - Middle Name:
Other - Last Name:JEFFREY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1880 WILLAMETTE FALLS DR STE 260
Mailing Address - Street 2:
Mailing Address - City:WEST LINN
Mailing Address - State:OR
Mailing Address - Zip Code:97068-4654
Mailing Address - Country:US
Mailing Address - Phone:503-701-7714
Mailing Address - Fax:503-594-8948
Practice Address - Street 1:1880 WILLAMETTE FALLS DR STE 260
Practice Address - Street 2:
Practice Address - City:WEST LINN
Practice Address - State:OR
Practice Address - Zip Code:97068-4654
Practice Address - Country:US
Practice Address - Phone:503-701-7714
Practice Address - Fax:503-594-8948
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-04
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR11539225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR11539OtherSTATE LICENSE