Provider Demographics
NPI:1952310708
Name:BLACK, MELINDA KAY (PT,DPT)
Entity Type:Individual
Prefix:MRS
First Name:MELINDA
Middle Name:KAY
Last Name:BLACK
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 1:12819 HWY 231 431 N
Mailing Address - Street 2:SUITE G
Mailing Address - City:HAZEL GREEN
Mailing Address - State:AL
Mailing Address - Zip Code:35750-8629
Mailing Address - Country:US
Mailing Address - Phone:256-829-9544
Mailing Address - Fax:256-829-9522
Practice Address - Street 1:12819 HWY 231 431 N
Practice Address - Street 2:SUITE G
Practice Address - City:HAZEL GREEN
Practice Address - State:AL
Practice Address - Zip Code:35750-8629
Practice Address - Country:US
Practice Address - Phone:256-829-9544
Practice Address - Fax:256-829-9522
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPT0000008834225100000X
ALPTH2496225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4137075OtherBLUE CROSS BLUE SHIELD
AL051517500OtherBLUE CROSS & BLUE SHIELD
AL051517500Medicaid
AL1952310708OtherUNITED HEALTH CARE
TN4137075OtherBLUE CROSS BLUE SHIELD
AL1063421857Medicare PIN