Provider Demographics
NPI:1154606762
Name:ELDER, MELINDA KAE (PT, DPT)
Entity type:Individual
Prefix:
First Name:MELINDA
Middle Name:KAE
Last Name:ELDER
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:MELINDA
Other - Middle Name:KAE
Other - Last Name:REDINGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8823 PRODUCTION LN
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-6511
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:
Practice Address - Street 1:2580 WINDY HILL RD SE
Practice Address - Street 2:STE. 300
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-8642
Practice Address - Country:US
Practice Address - Phone:770-916-1567
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-14
Last Update Date:2016-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT010468225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist