Provider Demographics
NPI:1790917284
Name:NEAL, MELISSA (DPT)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:
Last Name:NEAL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1612 RIDGECREST DR SE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87108-4437
Mailing Address - Country:US
Mailing Address - Phone:505-250-7049
Mailing Address - Fax:505-250-7049
Practice Address - Street 1:1612 RIDGECREST DR SE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87108-4437
Practice Address - Country:US
Practice Address - Phone:505-250-7049
Practice Address - Fax:505-250-7049
Is Sole Proprietor?:No
Enumeration Date:2009-08-17
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3737225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM1356491146OtherBELEN FACILITY NPI
NM000Q0406Medicaid
NM1386651412OtherBILLING NPI
NM1356491146OtherBELEN FACILITY NPI