Provider Demographics
NPI:1376579847
Name:MELOGRANA, KIERNAN ELIZABETH (ATC)
Entity Type:Individual
Prefix:MRS
First Name:KIERNAN
Middle Name:ELIZABETH
Last Name:MELOGRANA
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 BURKEY DR
Mailing Address - Street 2:
Mailing Address - City:WYOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610-1546
Mailing Address - Country:US
Mailing Address - Phone:610-678-3056
Mailing Address - Fax:
Practice Address - Street 1:2601 GRANDVIEW BLVD
Practice Address - Street 2:
Practice Address - City:WEST LAWN
Practice Address - State:PA
Practice Address - Zip Code:19609-1324
Practice Address - Country:US
Practice Address - Phone:610-670-0185
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART002414A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer