Provider Demographics
NPI:1730479403
Name:BALLINGTON, MELANIE (PTA)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:BALLINGTON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 SUMMIT HILLS DR
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29307-1532
Mailing Address - Country:US
Mailing Address - Phone:864-342-9275
Mailing Address - Fax:864-585-3705
Practice Address - Street 1:110 SUMMIT HILLS DR
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29307-1532
Practice Address - Country:US
Practice Address - Phone:864-342-9275
Practice Address - Fax:864-585-3705
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-14
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2555225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant