Provider Demographics
NPI:1346717485
Name:MUNOZ, MELITON
Entity Type:Individual
Prefix:MR
First Name:MELITON
Middle Name:
Last Name:MUNOZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1665 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DUNCAN
Mailing Address - State:SC
Mailing Address - Zip Code:29334-9217
Mailing Address - Country:US
Mailing Address - Phone:864-210-9673
Mailing Address - Fax:864-626-0795
Practice Address - Street 1:1665 E MAIN ST
Practice Address - Street 2:
Practice Address - City:DUNCAN
Practice Address - State:SC
Practice Address - Zip Code:29334-9217
Practice Address - Country:US
Practice Address - Phone:864-210-9673
Practice Address - Fax:864-626-0795
Is Sole Proprietor?:No
Enumeration Date:2018-10-26
Last Update Date:2018-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2594225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant