Healthcare Provider Details

I. General information

NPI: 1891182085
Provider Name (Legal Business Name): JON MELIA ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2015
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 BEN WEINER DR
NEW ORLEANS LA
70118-3370
US

IV. Provider business mailing address

2757 BIENVILLE ST
NEW ORLEANS LA
70119-5503
US

V. Phone/Fax

Practice location:
  • Phone: 479-313-2422
  • Fax:
Mailing address:
  • Phone: 479-644-2353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number343562
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: