Provider Demographics
NPI:1396166278
Name:FLETCHER, MELANIE MICHELLE (PT,DPT)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:MICHELLE
Last Name:FLETCHER
Suffix:
Gender:F
Credentials:PT,DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4350 SIGMA RD STE 100
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75244-4421
Mailing Address - Country:US
Mailing Address - Phone:972-991-6777
Mailing Address - Fax:
Practice Address - Street 1:4350 SIGMA RD STE 100
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75244-4421
Practice Address - Country:US
Practice Address - Phone:972-991-6777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-19
Last Update Date:2013-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11986832251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX751189353Medicaid