Provider Demographics
NPI:1144228065
Name:MCDONALD, MELANIE A (MPT)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:A
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:MELANIE
Other - Middle Name:A
Other - Last Name:KOZA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:2122 YORK RD STE 300
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1925
Mailing Address - Country:US
Mailing Address - Phone:630-575-6200
Mailing Address - Fax:630-575-7450
Practice Address - Street 1:2051 W CHANDLER BLVD STE 3
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-6239
Practice Address - Country:US
Practice Address - Phone:480-566-8150
Practice Address - Fax:480-566-8151
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-13
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3888225100000X
AZLPT-003888225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ26466Medicare UPIN
AZS92232Medicare UPIN