Healthcare Provider Details

I. General information

NPI: 1285153080
Provider Name (Legal Business Name): MELODY TRAN DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2017
Last Update Date: 01/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 E HURON ST SUITE 700
CHICAGO IL
60611
US

IV. Provider business mailing address

600 OAKMONT LANE SUITE 600C
WESTMONT IL
60559-5548
US

V. Phone/Fax

Practice location:
  • Phone: 312-640-1112
  • Fax: 312-640-1011
Mailing address:
  • Phone: 630-575-1980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number17400
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070024140
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: