Provider Demographics
NPI:1174687826
Name:HANAWALT, MELINDA K (PT)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:K
Last Name:HANAWALT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 E MARKET ST
Mailing Address - Street 2:
Mailing Address - City:ELMIRA
Mailing Address - State:NY
Mailing Address - Zip Code:14901-3223
Mailing Address - Country:US
Mailing Address - Phone:607-733-6541
Mailing Address - Fax:607-737-1532
Practice Address - Street 1:555 E MARKET ST
Practice Address - Street 2:
Practice Address - City:ELMIRA
Practice Address - State:NY
Practice Address - Zip Code:14901-3223
Practice Address - Country:US
Practice Address - Phone:607-733-6541
Practice Address - Fax:607-737-1532
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024915-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist