Provider Demographics
NPI:1427530989
Name:LLEVERINO, MELANIE DAWN (PTA)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:DAWN
Last Name:LLEVERINO
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:MELANIE
Other - Middle Name:KUTACH
Other - Last Name:LLEVERINO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PTA
Mailing Address - Street 1:3345 JOSHS WAY
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:TX
Mailing Address - Zip Code:78124-1377
Mailing Address - Country:US
Mailing Address - Phone:210-315-5440
Mailing Address - Fax:
Practice Address - Street 1:8610 N NEW BRAUNFELS AVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-6370
Practice Address - Country:US
Practice Address - Phone:210-804-0193
Practice Address - Fax:210-804-0194
Is Sole Proprietor?:No
Enumeration Date:2018-08-31
Last Update Date:2018-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant