Provider Demographics
NPI:1053028076
Name:CAVENDER, MELISSA MICHELLE (PT)
Entity type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:MICHELLE
Last Name:CAVENDER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:DR
Other - First Name:LISA
Other - Middle Name:MICHELLE
Other - Last Name:CAVENDER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:716 EVANS BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:HEFLIN
Mailing Address - State:AL
Mailing Address - Zip Code:36264-2148
Mailing Address - Country:US
Mailing Address - Phone:256-591-1877
Mailing Address - Fax:
Practice Address - Street 1:2111 US HIGHWAY 78 E
Practice Address - Street 2:
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36207-8357
Practice Address - Country:US
Practice Address - Phone:256-832-1988
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-31
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH5316225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist