Provider Demographics
NPI:1194374785
Name:WHITAKER, MELIA NICOLE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:MELIA
Middle Name:NICOLE
Last Name:WHITAKER
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6401 ELDORADO PKWY
Mailing Address - Street 2:STE 337
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-6520
Mailing Address - Country:US
Mailing Address - Phone:817-381-5177
Mailing Address - Fax:817-383-0049
Practice Address - Street 1:3455 HIGHWAY 81 SOUTH
Practice Address - Street 2:
Practice Address - City:LOGANVILLE
Practice Address - State:GA
Practice Address - Zip Code:30052-3918
Practice Address - Country:US
Practice Address - Phone:678-635-8280
Practice Address - Fax:678-635-8285
Is Sole Proprietor?:No
Enumeration Date:2019-09-06
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1326817225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist