Provider Demographics
NPI:1457400715
Name:HENDERSON, MELANIE ANN (PT)
Entity Type:Individual
Prefix:MRS
First Name:MELANIE
Middle Name:ANN
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MELANIE
Other - Middle Name:
Other - Last Name:HERKINS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, PT
Mailing Address - Street 1:504 ALBEMARLE SQ
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22901-7405
Mailing Address - Country:US
Mailing Address - Phone:434-817-7848
Mailing Address - Fax:434-465-3468
Practice Address - Street 1:375 FOUR LEAF LN
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22903-6905
Practice Address - Country:US
Practice Address - Phone:434-817-4283
Practice Address - Fax:434-509-4993
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305203612225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2595945OtherHIGHMARK PA BLUE SHIELD
PA102569630-0001Medicaid
PA215081VLZMedicare PIN