Provider Demographics
NPI:1407660855
Name:PECKLER, MELITZA (PTA)
Entity type:Individual
Prefix:
First Name:MELITZA
Middle Name:
Last Name:PECKLER
Suffix:
Gender:
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:816 S WISCONSIN ST
Mailing Address - Street 2:
Mailing Address - City:HOBART
Mailing Address - State:IN
Mailing Address - Zip Code:46342-5062
Mailing Address - Country:US
Mailing Address - Phone:219-718-9866
Mailing Address - Fax:
Practice Address - Street 1:1451 MORTHLAND DR STE B
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46385-6360
Practice Address - Country:US
Practice Address - Phone:219-286-3882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-05
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06006885A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant