Provider Demographics
NPI:1285658930
Name:VAIKASIENE, MELINDA M (PT)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:M
Last Name:VAIKASIENE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MELINDA
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11036 WOOLDRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20111
Mailing Address - Country:US
Mailing Address - Phone:703-361-1533
Mailing Address - Fax:
Practice Address - Street 1:11036 WOOLDRIDGE DR
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20111-2903
Practice Address - Country:US
Practice Address - Phone:703-361-1533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA23052041622251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics