Healthcare Provider Details

I. General information

NPI: 1639096936
Provider Name (Legal Business Name): MELODY MCDONALD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14280 WALSINGHAM RD
LARGO FL
33774-3231
US

IV. Provider business mailing address

14280 WALSINGHAM RD
LARGO FL
33774-3231
US

V. Phone/Fax

Practice location:
  • Phone: 727-596-2101
  • Fax:
Mailing address:
  • Phone: 727-596-2101
  • Fax: 727-596-2101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number15328PTA
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: