Provider Demographics
NPI:1740762624
Name:MELEGRITO, ELLEN CATAHAY
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:CATAHAY
Last Name:MELEGRITO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 CARMICHEAL CT
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-4369
Mailing Address - Country:US
Mailing Address - Phone:916-806-6785
Mailing Address - Fax:
Practice Address - Street 1:3400 E WALNUT ST
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77581-4716
Practice Address - Country:US
Practice Address - Phone:916-806-6785
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-06
Last Update Date:2018-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1213323225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty