Provider Demographics
NPI:1992805816
Name:JAMES, MELISSA ANN (PT)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANN
Last Name:JAMES
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:ANN
Other - Last Name:HAYNES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:17712 RICH EARTH LN
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73012-8778
Mailing Address - Country:US
Mailing Address - Phone:405-471-6899
Mailing Address - Fax:
Practice Address - Street 1:4300 W. MEMORIAL R, 5TH FLOOR MAIN HOSPITAL
Practice Address - Street 2:INPATIENT PHYSICAL MEDICINE
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120
Practice Address - Country:US
Practice Address - Phone:405-752-3770
Practice Address - Fax:405-936-5232
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2010-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1160589225100000X
OK3719225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8G4401Medicare ID - Type UnspecifiedMEDICARE