Healthcare Provider Details

I. General information

NPI: 1881736874
Provider Name (Legal Business Name): MELANIE RENEE MCCONNELL HOLTZ MPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 10/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

958 S KENMORE DR
EVANSVILLE IN
47714-7513
US

IV. Provider business mailing address

958 S KENMORE DR
EVANSVILLE IN
47714-7513
US

V. Phone/Fax

Practice location:
  • Phone: 812-477-5003
  • Fax: 812-477-3639
Mailing address:
  • Phone: 812-477-5003
  • Fax: 812-477-3639

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number05005845A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: