Provider Demographics
NPI:1578794764
Name:PURDY, MELISSA KAY (LMT)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:KAY
Last Name:PURDY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 FINDLEY ST
Mailing Address - Street 2:
Mailing Address - City:ELKINS
Mailing Address - State:WV
Mailing Address - Zip Code:26241-3309
Mailing Address - Country:US
Mailing Address - Phone:304-614-6600
Mailing Address - Fax:
Practice Address - Street 1:1520 HARRISON AVENUE
Practice Address - Street 2:
Practice Address - City:ELKINS
Practice Address - State:WV
Practice Address - Zip Code:26241-5514
Practice Address - Country:US
Practice Address - Phone:304-636-2340
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-05
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2004-1547225700000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist