Basic Information
| Provider Information | |||||||||
| NPI: | 1659784783 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ARAKAKI | ||||||||
| FirstName: | MELANIE | ||||||||
| MiddleName: | PAIGE | ||||||||
| NamePrefix: | |||||||||
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| Credential: | PT | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | ARAKAKI | ||||||||
| OtherFirstName: | MELANIE | ||||||||
| OtherMiddleName: | PAIGE | ||||||||
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| OtherCredential: | PT | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 790 REMINGTON BLVD | ||||||||
| Address2: | |||||||||
| City: | BOLINGBROOK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604404909 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6302962223 | ||||||||
| FaxNumber: | 6307599510 | ||||||||
| Practice Location | |||||||||
| Address1: | 7300 SECOR RD | ||||||||
| Address2: | |||||||||
| City: | LAMBERTVILLE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481449376 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7348541260 | ||||||||
| FaxNumber: | 7348543581 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/05/2014 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT60479889 | WA | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | 5501018250 | MI | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 1659784783 | 05 | WA | MEDICAID | 0328127 | 01 | WA | DEPT. OF LABOR AND INDUSTRIES | OTHER | 0328136 | 01 | WA | DEPT. OF LABOR AND INDUSTRIES | OTHER |