Provider Demographics
NPI:1619363256
Name:MELLOY, VALERIE (PTA)
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:
Last Name:MELLOY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8823 PRODUCTION LN
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-6511
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:423-238-3473
Practice Address - Street 1:6045 ALMA RD
Practice Address - Street 2:STE 320
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-2188
Practice Address - Country:US
Practice Address - Phone:214-495-0763
Practice Address - Fax:972-569-9076
Is Sole Proprietor?:No
Enumeration Date:2015-04-10
Last Update Date:2015-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2082867225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant