Basic Information
| Provider Information | |||||||||
| NPI: | 1194374785 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | WHITAKER | ||||||||
| FirstName: | MELIA | ||||||||
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| Credential: | PT, DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6401 ELDORADO PKWY | ||||||||
| Address2: | STE 337 | ||||||||
| City: | MCKINNEY | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750706520 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8173815177 | ||||||||
| FaxNumber: | 8173830049 | ||||||||
| Practice Location | |||||||||
| Address1: | 3455 HIGHWAY 81 SOUTH | ||||||||
| Address2: | |||||||||
| City: | LOGANVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300523918 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6786358280 | ||||||||
| FaxNumber: | 6786358285 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/06/2019 | ||||||||
| LastUpdateDate: | 04/26/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/26/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 1326817 | TX | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.