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NPI Code Detail

MEDICARE: MR. CLEVELAND PAUL MELANCON PT, OCS

MEDICARE: MR. CLEVELAND PAUL MELANCON PT, OCS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12251X0800XOrthopedic Physical Therapist01407LA

General Provider Information

NPI Number : 1205927209
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. CLEVELAND PAUL MELANCON PT, OCS
Provider Business Mailing Address
First Line : 17609 OLD JEFFERSON HWY
Second Line : SUITE G
City : PRAIRIEVILLE
State : LA
Zip : 70769-3979
Country : US
Telephone Number : 225-673-0200
Fax Number : 225-673-0202
Provider Business Practice Location Address
First Line : 17609 OLD JEFFERSON HWY
Second Line : SUITE G
City : PRAIRIEVILLE
State : LA
Zip : 70769-3979
Country : US
Telephone Number : 225-673-0200
Fax Number : 225-673-0202
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/27/2006
Last Update Date : 03/18/2008

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