Provider Demographics
NPI:1508931817
Name:MELOY, MARIA GRACELY GOPIAO (RPT)
Entity Type:Individual
Prefix:MRS
First Name:MARIA GRACELY
Middle Name:GOPIAO
Last Name:MELOY
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:MS
Other - First Name:MARIA GRACELY
Other - Middle Name:GOPIAO
Other - Last Name:SORONGON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1 MADELINE CT
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WV
Mailing Address - Zip Code:25130-1289
Mailing Address - Country:US
Mailing Address - Phone:304-345-0867
Mailing Address - Fax:304-342-2587
Practice Address - Street 1:1 MADELINE CT
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WV
Practice Address - Zip Code:25130-1289
Practice Address - Country:US
Practice Address - Phone:304-345-0867
Practice Address - Fax:304-342-2587
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2014-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1112225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0156761000Medicaid
WV0206427000Medicaid
WV0156761000Medicaid
WV0206427000Medicaid