Provider Demographics
NPI:1518713783
Name:KNAPP, MELINDA ALICE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:ALICE
Last Name:KNAPP
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4280 BRANCHE RD
Mailing Address - Street 2:
Mailing Address - City:CAPE VINCENT
Mailing Address - State:NY
Mailing Address - Zip Code:13618-3119
Mailing Address - Country:US
Mailing Address - Phone:315-771-2635
Mailing Address - Fax:
Practice Address - Street 1:2999 OLYMPUS BLVD STE 500
Practice Address - Street 2:
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019-1205
Practice Address - Country:US
Practice Address - Phone:315-771-2635
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-27
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1378916225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty