Provider Demographics
NPI:1568785822
Name:MINTZ, MELANIE NUGENT (DPT)
Entity Type:Individual
Prefix:MRS
First Name:MELANIE
Middle Name:NUGENT
Last Name:MINTZ
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MISS
Other - First Name:MELANIE
Other - Middle Name:ANN
Other - Last Name:NUGENT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:6033 FLEETWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70817-3830
Mailing Address - Country:US
Mailing Address - Phone:979-220-5570
Mailing Address - Fax:
Practice Address - Street 1:6033 FLEETWOOD DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70817-3830
Practice Address - Country:US
Practice Address - Phone:979-220-5570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-01
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35951225100000X
LA08468R225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist