Basic Information
| Provider Information | |||||||||
| NPI: | 1982826160 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MELTON | ||||||||
| FirstName: | AMY | ||||||||
| MiddleName: | LYNN | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11351 JAMES WATT DR | ||||||||
| Address2: | STE. A | ||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 799366627 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9152178709 | ||||||||
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| Practice Location | |||||||||
| Address1: | 11351 JAMES WATT DR | ||||||||
| Address2: | STE. A | ||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 799366627 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9158496602 | ||||||||
| FaxNumber: | 9158496603 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/03/2007 | ||||||||
| LastUpdateDate: | 09/24/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 1135705 | TX | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.