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General NPI Number Information
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NPI Number | 1093297525
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Entity Type | Individual
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Provider Name | MELANIE ANN ALDEA JENKINS PTA
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Gender | Female
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Dates
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Enumeration Date | 08/31/2018
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Last Update Date | 08/31/2018
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Provider Practice Location Address
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Address Line | 3000 CARDINAL ST
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City | ORANGE
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State | TX
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Zip | 77630-4737
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Country | US
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Telephone | 409-883-5727
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Fax |
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Provider Business Mailing Address
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Address Line | 2247 N 10TH ST APT 408
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City | BEAUMONT
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State | TX
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Zip | 77703-5040
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Country | US
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Telephone | 912-574-0410
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 2141206
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License Number State | TX
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