Provider Demographics
NPI:1891001335
Name:MELODY, ERIC ANDREW (MPT)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:ANDREW
Last Name:MELODY
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:375 HILLTOP AVE
Mailing Address - Street 2:
Mailing Address - City:KEYSER
Mailing Address - State:WV
Mailing Address - Zip Code:26726-2627
Mailing Address - Country:US
Mailing Address - Phone:240-743-9986
Mailing Address - Fax:
Practice Address - Street 1:2430 N 13TH ST
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:WA
Practice Address - Zip Code:98584-1213
Practice Address - Country:US
Practice Address - Phone:360-426-1651
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-22
Last Update Date:2010-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60169684225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist