MEDICARE: MELODY MCCULLOUGH PTA

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	225200000X	Physical Therapy Assistant	2064420	TX
2	225200000X	Physical Therapy Assistant	CP054272A	NH

General Provider Information

NPI Number	:	1891933065
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELODY MCCULLOUGH PTA

Provider Business Mailing Address
First Line	:	19406 BRIARSEDGE CT
Second Line	:
City	:	KATY
State	:	TX
Zip	:	77449-7506
Country	:	US
Telephone Number	:	281-579-2206
Fax Number	:

Provider Business Practice Location Address
First Line	:	23819 NORTHWOOD TERRACE LN
Second Line	:
City	:	KATY
State	:	TX
Zip	:	77493-7136
Country	:	US
Telephone Number	:	281-974-0383
Fax Number	:

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

Provider Enumeration Date	:	01/27/2009
Last Update Date	:	04/25/2026

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