Provider Demographics
NPI:1386217800
Name:HAMILT, MELANIE BROOKE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:BROOKE
Last Name:HAMILT
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203.5 6TH STREET
Mailing Address - Street 2:APT 6
Mailing Address - City:CORALVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52246
Mailing Address - Country:US
Mailing Address - Phone:770-639-3605
Mailing Address - Fax:
Practice Address - Street 1:1130 S SCOTT BLVD
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52240-2908
Practice Address - Country:US
Practice Address - Phone:319-354-2429
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-22
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA109066225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist