Provider Demographics
NPI:1730423187
Name:PARK, MELINDA JO (PT/ATC)
Entity type:Individual
Prefix:MRS
First Name:MELINDA
Middle Name:JO
Last Name:PARK
Suffix:
Gender:F
Credentials:PT/ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:614 MABRY HOOD RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37932-2669
Mailing Address - Country:US
Mailing Address - Phone:865-531-2204
Mailing Address - Fax:855-232-8604
Practice Address - Street 1:614 MABRY HOOD RD
Practice Address - Street 2:SUITE 301
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37932-2669
Practice Address - Country:US
Practice Address - Phone:865-531-2204
Practice Address - Fax:855-232-8604
Is Sole Proprietor?:No
Enumeration Date:2012-11-23
Last Update Date:2012-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT21385225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist