Healthcare Provider Details

I. General information

NPI: 1366428518
Provider Name (Legal Business Name): AMY J PATRICK-MELIN PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 SUPERIOR AVENUE, RESERVE SQUARE BLDG WEST GALLERY
CLEVELAND OH
44114
US

IV. Provider business mailing address

533 E MAIN ST
RAVENNA OH
44266-3218
US

V. Phone/Fax

Practice location:
  • Phone: 216-621-5275
  • Fax: 216-621-6711
Mailing address:
  • Phone: 330-297-9020
  • Fax: 330-297-9095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberLPT09645
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberLPT09645
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: