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General NPI Number Information
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NPI Number | 1376600817
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Entity Type | Organization
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Legal Business Name | MELADJOY THERAPY SERVICES INC
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Dates
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Enumeration Date | 01/03/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 54473 WHITE TAIL DR
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City | MISHAWAKA
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State | IN
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Zip | 46545-1849
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Country | US
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Telephone | 574-386-7555
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Fax |
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Provider Business Mailing Address
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Address Line | 54473 WHITE TAIL DR
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City | MISHAWAKA
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State | IN
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Zip | 46545-1849
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Country | US
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Telephone | 574-386-7555
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. MAYNARD VILLAVICENCIO UTAYDE
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Credential | PT
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Telephone | 574-386-7570
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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