Provider Demographics
NPI:1255466934
Name:LUNGER, MELINDA GROVE (PT)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:GROVE
Last Name:LUNGER
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 1:436 CHARNELTON ST
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-2626
Mailing Address - Country:US
Mailing Address - Phone:541-344-6446
Mailing Address - Fax:
Practice Address - Street 1:436 CHARNELTON ST
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-2626
Practice Address - Country:US
Practice Address - Phone:541-344-6446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR16462251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORJ344603OtherPACIFICSOURCE
OR838435003OtherREGENCE BLUE CROSS
OR134491Medicare ID - Type Unspecified