Provider Demographics
NPI:1417080995
Name:LEWIS, MELINDA NELSON (PT)
Entity Type:Individual
Prefix:MRS
First Name:MELINDA
Middle Name:NELSON
Last Name:LEWIS
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 1:3000 S STATE ROAD 135
Mailing Address - Street 2:SUITE 110
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-9607
Mailing Address - Country:US
Mailing Address - Phone:317-535-4075
Mailing Address - Fax:317-535-4076
Practice Address - Street 1:3000 S STATE ROAD 135
Practice Address - Street 2:SUITE 110
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-9607
Practice Address - Country:US
Practice Address - Phone:317-535-4075
Practice Address - Fax:317-535-4076
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05003490A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN05003490AOtherSTATE LICENSE NUMBER