Provider Demographics
NPI:1508817024
Name:RILEY, MELANIE (PT)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:RILEY
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 1:8823 PRODUCTION LN
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-6511
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:423-954-7408
Practice Address - Street 1:246 OLMSTED BLVD
Practice Address - Street 2:SUITE D
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374-6004
Practice Address - Country:US
Practice Address - Phone:910-235-0655
Practice Address - Fax:910-235-0665
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4529225100000X
NC3407225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP3407OtherPHYSICAL THERAPIST
SCGP4586Medicaid
SCQ341578482Medicare PIN