Provider Demographics
NPI:1104235068
Name:JARVIS, MELANIE (PT, DPT)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:JARVIS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8046 S RIVER RD
Mailing Address - Street 2:
Mailing Address - City:ALAMOSA
Mailing Address - State:CO
Mailing Address - Zip Code:81101-9631
Mailing Address - Country:US
Mailing Address - Phone:847-875-1600
Mailing Address - Fax:
Practice Address - Street 1:2261 ENTERPRISE DR
Practice Address - Street 2:
Practice Address - City:ALAMOSA
Practice Address - State:CO
Practice Address - Zip Code:81101-3603
Practice Address - Country:US
Practice Address - Phone:719-589-5851
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-05
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics