Provider Demographics
NPI:1851357404
Name:HADDOCK, MELISSA C (PT)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:C
Last Name:HADDOCK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:MELISSA
Other - Middle Name:C
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, JD
Mailing Address - Street 1:508 HOLLOWDALE
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73003-3026
Mailing Address - Country:US
Mailing Address - Phone:405-826-6446
Mailing Address - Fax:405-330-6556
Practice Address - Street 1:801 NW 63RD ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-7603
Practice Address - Country:US
Practice Address - Phone:405-879-9997
Practice Address - Fax:405-789-3397
Is Sole Proprietor?:No
Enumeration Date:2006-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2101225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist