Provider Demographics
NPI:1659665982
Name:MELLON, JR, JAMES A JR (DPT)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:A
Last Name:MELLON, JR
Suffix:JR
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1560 140TH AVENUE NE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005
Mailing Address - Country:US
Mailing Address - Phone:425-746-2475
Mailing Address - Fax:425-746-2471
Practice Address - Street 1:1560 140TH AVENUE NE
Practice Address - Street 2:SUITE 100
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005
Practice Address - Country:US
Practice Address - Phone:425-746-2475
Practice Address - Fax:425-746-2471
Is Sole Proprietor?:No
Enumeration Date:2011-06-03
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60214303225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist