Provider Demographics
NPI:1629536131
Name:HUSKEY, MELINDA SUE (PT)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:SUE
Last Name:HUSKEY
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 1:1821 NORTHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37803-6378
Mailing Address - Country:US
Mailing Address - Phone:865-374-0602
Mailing Address - Fax:
Practice Address - Street 1:1821 NORTHWOOD DR
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37803-6378
Practice Address - Country:US
Practice Address - Phone:865-374-0602
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-05
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6047225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist