Provider Demographics
NPI:1447608260
Name:MELNICK, CORA LOUISE BRAUN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:CORA
Middle Name:LOUISE BRAUN
Last Name:MELNICK
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:CORA
Other - Middle Name:LOUISE
Other - Last Name:BRAUN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:PO BOX 222
Mailing Address - Street 2:
Mailing Address - City:DENALI PARK
Mailing Address - State:AK
Mailing Address - Zip Code:99755-0222
Mailing Address - Country:US
Mailing Address - Phone:907-799-9554
Mailing Address - Fax:907-683-4240
Practice Address - Street 1:15B REVINE CREEK TRAIL
Practice Address - Street 2:
Practice Address - City:DENALI PARK
Practice Address - State:AK
Practice Address - Zip Code:99755-9975
Practice Address - Country:US
Practice Address - Phone:907-799-9554
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-02
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ12266PT225100000X
AK160179225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist