Provider Demographics
NPI:1457891343
Name:SPRINGSTON, MELANIE (PTA)
Entity Type:Individual
Prefix:MRS
First Name:MELANIE
Middle Name:
Last Name:SPRINGSTON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 MILLCREST TER
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112-4398
Mailing Address - Country:US
Mailing Address - Phone:804-464-2323
Mailing Address - Fax:804-464-2313
Practice Address - Street 1:14265 MIDLOTHIAN TPKE
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23113-6560
Practice Address - Country:US
Practice Address - Phone:804-464-2323
Practice Address - Fax:804-464-2313
Is Sole Proprietor?:No
Enumeration Date:2017-02-27
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2306602269225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant