Provider Demographics
NPI:1609973411
Name:DUTY, MELODY (PT)
Entity Type:Individual
Prefix:MRS
First Name:MELODY
Middle Name:
Last Name:DUTY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1824 COMMONS CIR
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-9537
Mailing Address - Country:US
Mailing Address - Phone:405-467-6782
Mailing Address - Fax:405-324-0971
Practice Address - Street 1:1824 COMMONS CIR
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-9537
Practice Address - Country:US
Practice Address - Phone:405-467-6782
Practice Address - Fax:405-324-0971
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK16962251P0200X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100835130AMedicaid
OK100835160BMedicaid