Provider Demographics
NPI:1194861088
Name:MERCOGLIANO, MELISSA AUTHIER (PT)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:AUTHIER
Last Name:MERCOGLIANO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:463 TREMONT ST WEST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98366-3521
Mailing Address - Country:US
Mailing Address - Phone:360-874-0745
Mailing Address - Fax:360-874-0846
Practice Address - Street 1:463 TREMONT ST WEST
Practice Address - Street 2:SUITE 100
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98366-3521
Practice Address - Country:US
Practice Address - Phone:360-874-0745
Practice Address - Fax:360-874-0846
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00003857225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5214359OtherAETNA
WA5414MEOtherREGENCE
WA137035OtherWA L&I
WA5414MEOtherREGENCE