Provider Demographics
NPI:1639557622
Name:MEDLEY-KEITH, MELODY (PT, DPT)
Entity Type:Individual
Prefix:MRS
First Name:MELODY
Middle Name:
Last Name:MEDLEY-KEITH
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 342348
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78734-0040
Mailing Address - Country:US
Mailing Address - Phone:512-261-0620
Mailing Address - Fax:
Practice Address - Street 1:1927 LOHMANS CROSSING RD STE 100
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78734-5241
Practice Address - Country:US
Practice Address - Phone:512-261-0620
Practice Address - Fax:512-261-9441
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-11
Last Update Date:2015-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1257670225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist