Provider Demographics
NPI:1639369614
Name:MOORE SCHNEBLY, MELINDA SUE (MPT)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:SUE
Last Name:MOORE SCHNEBLY
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2404 S LOCUST ST STE 5
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88001-5789
Mailing Address - Country:US
Mailing Address - Phone:505-521-4188
Mailing Address - Fax:505-521-3668
Practice Address - Street 1:2404 S LOCUST ST STE 5
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-5789
Practice Address - Country:US
Practice Address - Phone:505-521-4188
Practice Address - Fax:505-521-3668
Is Sole Proprietor?:No
Enumeration Date:2007-07-26
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3413225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM08736766Medicaid