Healthcare Provider Details

I. General information

NPI: 1295068310
Provider Name (Legal Business Name): MELINDA ANN RICHARDS PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2009
Last Update Date: 09/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 S COUNTY ROAD 525 E
AVON IN
46123-8361
US

IV. Provider business mailing address

445 S COUNTY ROAD 525 E
AVON IN
46123-8361
US

V. Phone/Fax

Practice location:
  • Phone: 317-745-2522
  • Fax: 317-745-2991
Mailing address:
  • Phone: 317-745-2522
  • Fax: 317-745-2991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number06000981A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: