Provider Demographics
NPI:1629218771
Name:MELODY PRINKLETON
Entity Type:Organization
Organization Name:MELODY PRINKLETON
Other - Org Name:MAKING WAVES PEDIATRIC THERAPY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICAL THERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELODY
Authorized Official - Middle Name:
Authorized Official - Last Name:PRINKLETON
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:502-212-5103
Mailing Address - Street 1:PO BOX 99977
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40269-0977
Mailing Address - Country:US
Mailing Address - Phone:502-212-5103
Mailing Address - Fax:502-749-2226
Practice Address - Street 1:4103 BOLLLING BROOK DRIVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40299
Practice Address - Country:US
Practice Address - Phone:502-212-5103
Practice Address - Fax:502-212-5103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-03
Last Update Date:2009-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY003948252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency