Provider Demographics
NPI:1922145317
Name:WALCK, MELINDA SHOOP (PT)
Entity Type:Individual
Prefix:MRS
First Name:MELINDA
Middle Name:SHOOP
Last Name:WALCK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:MELINDA
Other - Middle Name:LOUISE
Other - Last Name:SHOOP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:21 E 7TH ST
Mailing Address - Street 2:
Mailing Address - City:JIM THORPE
Mailing Address - State:PA
Mailing Address - Zip Code:18229-2519
Mailing Address - Country:US
Mailing Address - Phone:570-412-6049
Mailing Address - Fax:
Practice Address - Street 1:575 SOUTH 9TH STREET
Practice Address - Street 2:SUITE 2
Practice Address - City:LEHIGHTON
Practice Address - State:PA
Practice Address - Zip Code:18235
Practice Address - Country:US
Practice Address - Phone:570-645-1035
Practice Address - Fax:570-645-1036
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2019-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT014208L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist