Provider Demographics
NPI:1770121212
Name:SEGBERS, MELANEY (LPTA)
Entity type:Individual
Prefix:
First Name:MELANEY
Middle Name:
Last Name:SEGBERS
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3912 WILMINGTON RD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23453-1711
Mailing Address - Country:US
Mailing Address - Phone:216-287-6865
Mailing Address - Fax:
Practice Address - Street 1:249 S NEWTOWN RD
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-5718
Practice Address - Country:US
Practice Address - Phone:757-427-4700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-16
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2306604017225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant