Provider Demographics
NPI:1295168359
Name:COBB, MELANIE DENICE (PT, DPT, CSCS)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:DENICE
Last Name:COBB
Suffix:
Gender:F
Credentials:PT, DPT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:292 SHADOW MOSS CIR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HILL
Mailing Address - State:GA
Mailing Address - Zip Code:31324-7322
Mailing Address - Country:US
Mailing Address - Phone:956-573-6276
Mailing Address - Fax:
Practice Address - Street 1:5568 GENERAL WASHINGTON DR STE A203
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22312-2465
Practice Address - Country:US
Practice Address - Phone:703-663-8864
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-13
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN9776225100000X
OHPT018258225100000X
VA2305210080225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist