Provider Demographics
NPI:1508815952
Name:HUMPHRIES, MELANIE COOKE (PT)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:COOKE
Last Name:HUMPHRIES
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 1:7277 NC HWY 42 W SUITE 208
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27603
Mailing Address - Country:US
Mailing Address - Phone:919-733-4086
Mailing Address - Fax:919-773-4087
Practice Address - Street 1:7277 NC HWY 42 W SUITE 208
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27603
Practice Address - Country:US
Practice Address - Phone:919-733-4086
Practice Address - Fax:919-733-4087
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2025-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP8760225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC078YYOtherBCBS
NC7211593Medicaid
NC7211593Medicaid