=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598895583
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MELANIE HINES PT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/07/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 383 CORBIN CENTER DRIVE
-----------------------------------------------------
City | CORBIN
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40701
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 606-526-2919
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 332 EZRA WALLS RD
-----------------------------------------------------
City | LIBERTY
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 42539-7842
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 606-526-2919
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 002434
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------