Provider Demographics
NPI:1679543201
Name:WELLER, MELANIE MALERICH (PT)
Entity type:Individual
Prefix:MS
First Name:MELANIE
Middle Name:MALERICH
Last Name:WELLER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:714 BORDEAUX ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70115-1610
Mailing Address - Country:US
Mailing Address - Phone:703-946-8456
Mailing Address - Fax:877-257-8223
Practice Address - Street 1:714 BORDEAUX ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70115-1610
Practice Address - Country:US
Practice Address - Phone:703-946-8456
Practice Address - Fax:877-257-8223
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2009-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT22243225100000X
VA23050006230225100000X
LA07631R2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist