Provider Demographics
NPI:1922438993
Name:ACKERLY, MELANIE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:ACKERLY
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4310 PARK RD APT 102
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28209-0006
Mailing Address - Country:US
Mailing Address - Phone:802-372-3029
Mailing Address - Fax:980-206-4166
Practice Address - Street 1:4310 PARK RD APT 102
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28209-0006
Practice Address - Country:US
Practice Address - Phone:980-237-2302
Practice Address - Fax:980-206-4166
Is Sole Proprietor?:No
Enumeration Date:2013-11-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP16213225100000X
OHPT.014577225100000X
SC7312225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist