Provider Demographics
NPI:1093297525
Name:JENKINS, MELANIE ANN ALDEA (PTA)
Entity Type:Individual
Prefix:
First Name:MELANIE ANN
Middle Name:ALDEA
Last Name:JENKINS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2247 N 10TH ST APT 408
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77703-5040
Mailing Address - Country:US
Mailing Address - Phone:912-574-0410
Mailing Address - Fax:
Practice Address - Street 1:3000 CARDINAL ST
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:TX
Practice Address - Zip Code:77630-4737
Practice Address - Country:US
Practice Address - Phone:409-883-5727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-31
Last Update Date:2018-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2141206225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant