Healthcare Provider Details

I. General information

NPI: 1194870857
Provider Name (Legal Business Name): MELODY PRINKLETON PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELODY HOLLIMAN

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 03/11/2024
Certification Date: 03/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4103 BOLLING BROOK DR
LOUISVILLE KY
40299-5493
US

IV. Provider business mailing address

4103 BOLLING BROOK DR
LOUISVILLE KY
40299-5493
US

V. Phone/Fax

Practice location:
  • Phone: 859-492-7257
  • Fax:
Mailing address:
  • Phone: 859-492-7257
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number003948
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: