MEDICARE: MS. MELANIE MALERICH WELLER PT

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
1	225100000X	Physical Therapist	PT22243	CA
2	225100000X	Physical Therapist	23050006230	VA
3	2251X0800X	Orthopedic Physical Therapist	07631R	LA

General Provider Information

NPI Number	:	1679543201
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MELANIE MALERICH WELLER PT

Provider Business Mailing Address
First Line	:	714 BORDEAUX ST
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70115-1610
Country	:	US
Telephone Number	:	703-946-8456
Fax Number	:	877-257-8223

Provider Business Practice Location Address
First Line	:	714 BORDEAUX ST
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70115-1610
Country	:	US
Telephone Number	:	703-946-8456
Fax Number	:	877-257-8223

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/25/2006
Last Update Date	:	10/07/2009

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