Provider Demographics
NPI:1992399257
Name:WAINMAN, MELISSA JOY (PT)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:JOY
Last Name:WAINMAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7831 PARK LN
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75225-2000
Mailing Address - Country:US
Mailing Address - Phone:214-369-9905
Mailing Address - Fax:214-234-0206
Practice Address - Street 1:7831 PARK LN
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75225-2000
Practice Address - Country:US
Practice Address - Phone:214-369-9905
Practice Address - Fax:214-234-0206
Is Sole Proprietor?:No
Enumeration Date:2021-02-25
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1096881225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist