Provider Demographics
NPI:1699748368
Name:SPANGLE, MELVA J (PT)
Entity type:Individual
Prefix:
First Name:MELVA
Middle Name:J
Last Name:SPANGLE
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 1:7814 KELLY BEACH RD SE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98513-5214
Mailing Address - Country:US
Mailing Address - Phone:360-438-2759
Mailing Address - Fax:
Practice Address - Street 1:7306 STINSON AVE
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-1140
Practice Address - Country:US
Practice Address - Phone:253-858-3332
Practice Address - Fax:253-858-3327
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00002474225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8341760Medicaid
WAAB2900Medicare ID - Type Unspecified