Provider Demographics
NPI:1447520994
Name:KING, MELINDA MARIE (LPTA)
Entity type:Individual
Prefix:MRS
First Name:MELINDA
Middle Name:MARIE
Last Name:KING
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:MELINDA
Other - Middle Name:MARIE
Other - Last Name:MERRITT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2197 ROUTE 20
Mailing Address - Street 2:
Mailing Address - City:EAST DURHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12423-1541
Mailing Address - Country:US
Mailing Address - Phone:518-239-6934
Mailing Address - Fax:
Practice Address - Street 1:2197 ROUTE 20
Practice Address - Street 2:
Practice Address - City:EAST DURHAM
Practice Address - State:NY
Practice Address - Zip Code:12423-1541
Practice Address - Country:US
Practice Address - Phone:518-239-6934
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-30
Last Update Date:2011-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006418-1225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant