=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104056571
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ABBEY LOUISE MELLING PT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/20/2009
-----------------------------------------------------
Last Update Date | 07/20/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1 W SUPERIOR ST APT. 908
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60654-8803
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-477-4567
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1 W SUPERIOR ST APT. 908
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60654-8803
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-477-4567
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2251P0200X
-----------------------------------------------------
Taxonomy Name | Pediatric Physical Therapist
-----------------------------------------------------
License Number | 070.016506
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------