Provider Demographics
NPI:1801229349
Name:WALL, MELINDA I (PTA)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:I
Last Name:WALL
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 1:115 ACADEMY ST
Mailing Address - Street 2:
Mailing Address - City:DICKSON
Mailing Address - State:TN
Mailing Address - Zip Code:37055-2013
Mailing Address - Country:US
Mailing Address - Phone:615-446-2085
Mailing Address - Fax:
Practice Address - Street 1:115 ACADEMY ST
Practice Address - Street 2:
Practice Address - City:DICKSON
Practice Address - State:TN
Practice Address - Zip Code:37055-2013
Practice Address - Country:US
Practice Address - Phone:615-446-2085
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-20
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant