Healthcare Provider Details

I. General information

NPI: 1104922475
Provider Name (Legal Business Name): MELANIE MASSEY PHYSICAL THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 03/11/2025
Certification Date: 03/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3177 STERLINGTON RD
MONROE LA
71203-2517
US

IV. Provider business mailing address

PO BOX 1377
WEST MONROE LA
71294
US

V. Phone/Fax

Practice location:
  • Phone: 318-388-1989
  • Fax:
Mailing address:
  • Phone: 318-396-1969
  • Fax: 318-396-1970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DONNA SHIREY
Title or Position: CREDENTIALING COORDINATOR
Credential:
Phone: 318-504-4316