Provider Demographics
NPI:1871832469
Name:LOOP, MELANIE DAWN (PTA)
Entity Type:Individual
Prefix:MRS
First Name:MELANIE
Middle Name:DAWN
Last Name:LOOP
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 1:1940 CHALYBEATE RD
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15522-8510
Mailing Address - Country:US
Mailing Address - Phone:814-623-2700
Mailing Address - Fax:
Practice Address - Street 1:208 PENNKNOLL RD
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:PA
Practice Address - Zip Code:15537-6940
Practice Address - Country:US
Practice Address - Phone:814-623-3240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-03
Last Update Date:2013-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATEI002418225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant