Provider Demographics
NPI:1366578643
Name:BYRNES, MELANI (PT)
Entity type:Individual
Prefix:
First Name:MELANI
Middle Name:
Last Name:BYRNES
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 1:701 WEST WETMORE RD. RM. 168
Mailing Address - Street 2:PIMA COUNTY AMPHITHEATER SCHOOLS DBA AMPHITHEATER PUBLI
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85705-1547
Mailing Address - Country:US
Mailing Address - Phone:520-696-5237
Mailing Address - Fax:520-696-5067
Practice Address - Street 1:701 WEST WETMORE RD. RM. 168
Practice Address - Street 2:AMPHITHEATER PUBLIC SCHOOLS
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85705-1547
Practice Address - Country:US
Practice Address - Phone:520-696-5237
Practice Address - Fax:520-696-5067
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2011-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4117225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ495566Medicaid