Provider Demographics
NPI:1447668983
Name:CABANISS, MELANIE BLACKBURN (DPT)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:BLACKBURN
Last Name:CABANISS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:MELANIE
Other - Middle Name:JOYCE
Other - Last Name:BLACKBURN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:201 SMYTHE ST APT 201
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29611-3570
Mailing Address - Country:US
Mailing Address - Phone:334-294-2056
Mailing Address - Fax:
Practice Address - Street 1:208 JAMES ST
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29625-2942
Practice Address - Country:US
Practice Address - Phone:864-226-3427
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-29
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7436225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist