Provider Demographics
NPI:1750169215
Name:THREADGILL, MELISSA CHRISTINE (R-DMT)
Entity type:Individual
Prefix:MISS
First Name:MELISSA
Middle Name:CHRISTINE
Last Name:THREADGILL
Suffix:
Gender:F
Credentials:R-DMT
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:704 SPRINGFIELD CT
Mailing Address - Street 2:
Mailing Address - City:DOWNINGTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19335-4200
Mailing Address - Country:US
Mailing Address - Phone:610-716-2464
Mailing Address - Fax:
Practice Address - Street 1:80 KLEYONA AVE
Practice Address - Street 2:
Practice Address - City:PHOENIXVILLE
Practice Address - State:PA
Practice Address - Zip Code:19460-2568
Practice Address - Country:US
Practice Address - Phone:610-716-2464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-18
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225600000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDance Therapist