Provider Demographics
NPI:1316711732
Name:CLOUSE, MELINDA (PT)
Entity type:Individual
Prefix:
First Name:MELINDA
Middle Name:
Last Name:CLOUSE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 LITTLE FALLS ST STE 410
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22046-4302
Mailing Address - Country:US
Mailing Address - Phone:703-244-6884
Mailing Address - Fax:703-940-1077
Practice Address - Street 1:200 LITTLE FALLS ST STE 410
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22046-4302
Practice Address - Country:US
Practice Address - Phone:703-244-6884
Practice Address - Fax:703-940-1077
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-07
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305004641261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy