Provider Demographics
NPI:1205927209
Name:MELANCON, CLEVELAND PAUL (PT, OCS)
Entity type:Individual
Prefix:MR
First Name:CLEVELAND
Middle Name:PAUL
Last Name:MELANCON
Suffix:
Gender:M
Credentials:PT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17609 OLD JEFFERSON HWY
Mailing Address - Street 2:SUITE G
Mailing Address - City:PRAIRIEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70769-3979
Mailing Address - Country:US
Mailing Address - Phone:225-673-0200
Mailing Address - Fax:225-673-0202
Practice Address - Street 1:17609 OLD JEFFERSON HWY
Practice Address - Street 2:SUITE G
Practice Address - City:PRAIRIEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70769-3979
Practice Address - Country:US
Practice Address - Phone:225-673-0200
Practice Address - Fax:225-673-0202
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA014072251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic