Provider Demographics
NPI:1932343803
Name:KILLAM, MELANIE SHOWALTER
Entity Type:Individual
Prefix:MRS
First Name:MELANIE
Middle Name:SHOWALTER
Last Name:KILLAM
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:MELANIE
Other - Middle Name:SUE
Other - Last Name:SHOWALTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:245 CAHABA VALLEY PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PELHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35124-2216
Mailing Address - Country:US
Mailing Address - Phone:205-942-6820
Mailing Address - Fax:205-942-5884
Practice Address - Street 1:715 EAST LAUREL STREET
Practice Address - Street 2:ATMORE NURSING CENTER
Practice Address - City:ATMORE
Practice Address - State:AL
Practice Address - Zip Code:36502
Practice Address - Country:US
Practice Address - Phone:251-368-9121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-23
Last Update Date:2009-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1987225100000X
FL7117225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist