Provider Demographics
NPI:1316084528
Name:LEDSON, MELISSA DAWN (RPT)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:DAWN
Last Name:LEDSON
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 JOHNSON AVE
Mailing Address - Street 2:SUITE 4S
Mailing Address - City:BRIDGEPORT
Mailing Address - State:WV
Mailing Address - Zip Code:26330-1063
Mailing Address - Country:US
Mailing Address - Phone:304-842-0307
Mailing Address - Fax:304-842-0315
Practice Address - Street 1:US 52 STONECOAL SUITE 2
Practice Address - Street 2:
Practice Address - City:CRUM
Practice Address - State:WV
Practice Address - Zip Code:25669
Practice Address - Country:US
Practice Address - Phone:304-842-0307
Practice Address - Fax:304-842-0315
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2008-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV002607225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810011332Medicaid
WV7415904OtherAETNA
WV001958593OtherMOUNTAIN STATE BCBS
WV1071301OtherWORKERS COMP, BRICKSTREET
WV7415904OtherAETNA
WV3810011332Medicaid