Provider Demographics
NPI:1689199622
Name:BUGARIN, MELODY BALAJADIA (PT)
Entity Type:Individual
Prefix:MRS
First Name:MELODY
Middle Name:BALAJADIA
Last Name:BUGARIN
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 1:11650 POSSUM HOLLOW LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77065-2909
Mailing Address - Country:US
Mailing Address - Phone:832-688-9335
Mailing Address - Fax:832-604-7180
Practice Address - Street 1:11650 POSSUM HOLLOW LN
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77065-2909
Practice Address - Country:US
Practice Address - Phone:832-688-9335
Practice Address - Fax:832-604-7180
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-10
Last Update Date:2017-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1087658225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist