Healthcare Provider Details

I. General information

NPI: 1780179093
Provider Name (Legal Business Name): MELANIE FAJARDO PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2018
Last Update Date: 06/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 YORKLYN RD STE 150
HOCKESSIN DE
19707-8729
US

IV. Provider business mailing address

1819 W 16TH ST
WILMINGTON DE
19806-2520
US

V. Phone/Fax

Practice location:
  • Phone: 302-234-2288
  • Fax:
Mailing address:
  • Phone: 301-642-1387
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberJ1-0003918
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: