Provider Demographics
NPI:1659775641
Name:RATTANAPOTE-MALANEY, MELODY K (DPT)
Entity Type:Individual
Prefix:
First Name:MELODY
Middle Name:K
Last Name:RATTANAPOTE-MALANEY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:MELODY
Other - Middle Name:
Other - Last Name:RATTANAPOTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:PO BOX 516626
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90051-0600
Mailing Address - Country:US
Mailing Address - Phone:505-836-4899
Mailing Address - Fax:505-214-5030
Practice Address - Street 1:1400 MAIN ST.
Practice Address - Street 2:STE 1-2
Practice Address - City:SOCORRO
Practice Address - State:NM
Practice Address - Zip Code:87801-3914
Practice Address - Country:US
Practice Address - Phone:058-364-8995
Practice Address - Fax:505-214-5030
Is Sole Proprietor?:No
Enumeration Date:2014-10-20
Last Update Date:2018-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM4590225100000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program