Provider Demographics
NPI:1992956668
Name:JABEZ, MELODY ANTORA (DPT)
Entity type:Individual
Prefix:
First Name:MELODY
Middle Name:ANTORA
Last Name:JABEZ
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:MELODY
Other - Middle Name:ANTORA
Other - Last Name:BAIRAGEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:127 S. 500 E.
Mailing Address - Street 2:SUITE 600
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102-1971
Mailing Address - Country:US
Mailing Address - Phone:801-587-6336
Mailing Address - Fax:801-715-8228
Practice Address - Street 1:5547 S 4015 W
Practice Address - Street 2:#7
Practice Address - City:TAYLORSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84129-4429
Practice Address - Country:US
Practice Address - Phone:801-967-6055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-30
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05009691A225100000X
UT763725024012251X0800X
CA35476225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTU000072980Medicare PIN