Provider Demographics
NPI:1871799536
Name:MAVREDES, MELYNOR BERNABE (PT)
Entity type:Individual
Prefix:MRS
First Name:MELYNOR
Middle Name:BERNABE
Last Name:MAVREDES
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:8824 PEBBLE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-2844
Mailing Address - Country:US
Mailing Address - Phone:423-855-0488
Mailing Address - Fax:
Practice Address - Street 1:1 SISKIN PLZ
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403-1306
Practice Address - Country:US
Practice Address - Phone:423-634-1547
Practice Address - Fax:423-634-1394
Is Sole Proprietor?:No
Enumeration Date:2007-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000002218225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist