Provider Demographics
NPI:1457661563
Name:STANHOPE., MELODY MICHELE (DPT)
Entity Type:Individual
Prefix:DR
First Name:MELODY
Middle Name:MICHELE
Last Name:STANHOPE.
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4640 WEDGEWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21703-7114
Mailing Address - Country:US
Mailing Address - Phone:240-457-9558
Mailing Address - Fax:
Practice Address - Street 1:4640 WEDGEWOOD BLVD
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21703-7114
Practice Address - Country:US
Practice Address - Phone:240-457-9558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-08
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ1-0002628174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEJ1-0002628OtherPT LICENSE #