Provider Demographics
NPI:1679962062
Name:MELVIN JR, WALTER FRANK II (PTA)
Entity Type:Individual
Prefix:MR
First Name:WALTER
Middle Name:FRANK
Last Name:MELVIN JR
Suffix:II
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:WALTER
Other - Middle Name:
Other - Last Name:MELVIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1994 STEEPLECHASE DR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08094-8780
Mailing Address - Country:US
Mailing Address - Phone:609-617-2798
Mailing Address - Fax:
Practice Address - Street 1:113 ROUTE 73
Practice Address - Street 2:
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-9573
Practice Address - Country:US
Practice Address - Phone:856-809-3500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-22
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QB00224000225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant