Provider Demographics
NPI:1366987992
Name:MELENDEZ, NADIA
Entity type:Individual
Prefix:
First Name:NADIA
Middle Name:
Last Name:MELENDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13610 BARRETT OFFICE DR
Mailing Address - Street 2:210
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63021-7816
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13610 BARRETT OFFICE DR
Practice Address - Street 2:210
Practice Address - City:BALLWIN
Practice Address - State:MO
Practice Address - Zip Code:63021-7816
Practice Address - Country:US
Practice Address - Phone:314-822-5106
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-06
Last Update Date:2017-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012025720225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant