Provider Demographics
NPI:1326282450
Name:ROBSON, MELINDA (PT)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:
Last Name:ROBSON
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:PO BOX 3893
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88202-3893
Mailing Address - Country:US
Mailing Address - Phone:575-625-2525
Mailing Address - Fax:575-627-5934
Practice Address - Street 1:109 W BLAND ST
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88203-5708
Practice Address - Country:US
Practice Address - Phone:575-625-2525
Practice Address - Fax:575-627-5934
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-20
Last Update Date:2009-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2078225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist