Provider Demographics
NPI:1538477427
Name:MCKEON POWERS, MELISSA APRIL (PT, DPT, MED)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:APRIL
Last Name:MCKEON POWERS
Suffix:
Gender:F
Credentials:PT, DPT, MED
Other - Prefix:DR
Other - First Name:MELISSA
Other - Middle Name:APRIL
Other - Last Name:MCKEON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT, MED
Mailing Address - Street 1:1440 PELHAM ROAD, SUITE A
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615
Mailing Address - Country:US
Mailing Address - Phone:864-729-1319
Mailing Address - Fax:864-729-3726
Practice Address - Street 1:1440 PELHAM RD, SUITE A
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615
Practice Address - Country:US
Practice Address - Phone:864-729-1319
Practice Address - Fax:864-729-3726
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-14
Last Update Date:2015-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA19022225100000X
SC62732251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist