Provider Demographics
NPI:1376600817
Name:MELADJOY THERAPY SERVICES INC
Entity Type:Organization
Organization Name:MELADJOY THERAPY SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MAYNARD
Authorized Official - Middle Name:VILLAVICENCIO
Authorized Official - Last Name:UTAYDE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:574-386-7570
Mailing Address - Street 1:54473 WHITE TAIL DR
Mailing Address - Street 2:
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46545-1849
Mailing Address - Country:US
Mailing Address - Phone:574-386-7555
Mailing Address - Fax:
Practice Address - Street 1:54473 WHITE TAIL DR
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46545-1849
Practice Address - Country:US
Practice Address - Phone:574-386-7555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy