Provider Demographics
NPI:1982793576
Name:FERRELL, MELINDA G (PT)
Entity Type:Individual
Prefix:MRS
First Name:MELINDA
Middle Name:G
Last Name:FERRELL
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 1:740 E WASHINGTON ST
Mailing Address - Street 2:E4
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256
Mailing Address - Country:US
Mailing Address - Phone:330-722-3781
Mailing Address - Fax:330-725-6294
Practice Address - Street 1:740 E WASHINGTON ST
Practice Address - Street 2:E4
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256
Practice Address - Country:US
Practice Address - Phone:330-722-3781
Practice Address - Fax:330-725-6294
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT2612208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0947275Medicaid
OHFE40618191Medicare PIN