Provider Demographics
NPI:1689829699
Name:MELOCOTON, ANGELINA FIDELINO (PT)
Entity Type:Individual
Prefix:MRS
First Name:ANGELINA
Middle Name:FIDELINO
Last Name:MELOCOTON
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 1:2625 KIPLING DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62711-6232
Mailing Address - Country:US
Mailing Address - Phone:217-220-2861
Mailing Address - Fax:217-698-8287
Practice Address - Street 1:2625 KIPLING DR
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62711-6232
Practice Address - Country:US
Practice Address - Phone:217-220-2861
Practice Address - Fax:217-698-8287
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-19
Last Update Date:2008-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070008877225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist