Provider Demographics
NPI:1386880151
Name:ROTZ, MELANIE SELENE (PT)
Entity type:Individual
Prefix:MRS
First Name:MELANIE
Middle Name:SELENE
Last Name:ROTZ
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 1:1510 PECAN TRACE CT
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-6224
Mailing Address - Country:US
Mailing Address - Phone:832-496-0456
Mailing Address - Fax:
Practice Address - Street 1:1510 PECAN TRACE CT
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-6224
Practice Address - Country:US
Practice Address - Phone:832-496-0456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-29
Last Update Date:2008-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11488052251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics