Provider Demographics
NPI:1669528584
Name:GRIFFIN-DAVIS, MELANIE S (PT)
Entity type:Individual
Prefix:MRS
First Name:MELANIE
Middle Name:S
Last Name:GRIFFIN-DAVIS
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 1:11821 LEE ST
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-8798
Mailing Address - Country:US
Mailing Address - Phone:219-629-2064
Mailing Address - Fax:
Practice Address - Street 1:6504 E 129TH AVE
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-9087
Practice Address - Country:US
Practice Address - Phone:219-662-7654
Practice Address - Fax:219-662-2136
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05008560A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000356933OtherANTHEM