Provider Demographics
NPI:1194010223
Name:CONNER, MELINDA JOYCE (DPT)
Entity Type:Individual
Prefix:MRS
First Name:MELINDA
Middle Name:JOYCE
Last Name:CONNER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14024 COVERED WAGON TRL
Mailing Address - Street 2:
Mailing Address - City:LEO
Mailing Address - State:IN
Mailing Address - Zip Code:46765-9306
Mailing Address - Country:US
Mailing Address - Phone:260-760-2289
Mailing Address - Fax:
Practice Address - Street 1:5202 SAINT JOE RD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46835-3380
Practice Address - Country:US
Practice Address - Phone:260-485-6068
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-16
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05010033A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist