Provider Demographics
NPI:1790358950
Name:AMERSON, MELAINE KIMBERLY JOY (LMT)
Entity Type:Individual
Prefix:
First Name:MELAINE
Middle Name:KIMBERLY JOY
Last Name:AMERSON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7900 OLD MADISON PIKE APT 14005
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-2432
Mailing Address - Country:US
Mailing Address - Phone:256-278-9470
Mailing Address - Fax:
Practice Address - Street 1:9694 MADISON BLVD STE A13
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-9140
Practice Address - Country:US
Practice Address - Phone:256-517-2040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-23
Last Update Date:2021-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3750225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty