Provider Demographics
NPI:1881736874
Name:MCCONNELL HOLTZ, MELANIE RENEE (MPT)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:RENEE
Last Name:MCCONNELL HOLTZ
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:958 S KENMORE DR
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47714-7513
Mailing Address - Country:US
Mailing Address - Phone:812-477-5003
Mailing Address - Fax:812-477-3639
Practice Address - Street 1:958 S KENMORE DR
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47714-7513
Practice Address - Country:US
Practice Address - Phone:812-477-5003
Practice Address - Fax:812-477-3639
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05005845A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN224990AMedicare ID - Type UnspecifiedMEDICARE NUMBER