Provider Demographics
NPI:1194870857
Name:PRINKLETON, MELODY (PT, DPT)
Entity type:Individual
Prefix:
First Name:MELODY
Middle Name:
Last Name:PRINKLETON
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:MELODY
Other - Middle Name:
Other - Last Name:HOLLIMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4103 BOLLING BROOK DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40299-5493
Mailing Address - Country:US
Mailing Address - Phone:859-492-7257
Mailing Address - Fax:
Practice Address - Street 1:4103 BOLLING BROOK DR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40299-5493
Practice Address - Country:US
Practice Address - Phone:859-492-7257
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0039482251P0200X
2251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics