Provider Demographics
NPI:1396772901
Name:EBERHARDT, MELINDA R (ATC)
Entity type:Individual
Prefix:
First Name:MELINDA
Middle Name:R
Last Name:EBERHARDT
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 PINE AVE
Mailing Address - Street 2:APT 224
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-4594
Mailing Address - Country:US
Mailing Address - Phone:314-607-3145
Mailing Address - Fax:
Practice Address - Street 1:1200 E COLTON AVE
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92374-3755
Practice Address - Country:US
Practice Address - Phone:909-748-8430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer