Healthcare Provider Details

I. General information

NPI: 1326282450
Provider Name (Legal Business Name): MELINDA ROBSON PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2009
Last Update Date: 04/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 W BLAND ST
ROSWELL NM
88203-5708
US

IV. Provider business mailing address

PO BOX 3893
ROSWELL NM
88202-3893
US

V. Phone/Fax

Practice location:
  • Phone: 575-625-2525
  • Fax: 575-627-5934
Mailing address:
  • Phone: 575-625-2525
  • Fax: 575-627-5934

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2078
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: