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General NPI Number Information
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NPI Number | 1497911614
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Entity Type | Individual
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Provider Name | MELINDA CLARK POLING MPT
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Gender | Female
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Dates
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Enumeration Date | 08/07/2008
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Last Update Date | 08/07/2008
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Provider Practice Location Address
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Address Line | 100 BERKELEY DRIVE
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City | HAMILTON
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State | OH
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Zip | 45013
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Country | US
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Telephone | 513-785-2019
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Fax |
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Provider Business Mailing Address
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Address Line | 7933 WAINWRIGHT LANE
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City | MAINEVILLE
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State | OH
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Zip | 45039
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Country | US
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Telephone | 513-295-5198
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT-10681
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License Number State | OH
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