Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | LPT09645 | OH |
N | 2251S0007X | Physical Therapist - Sports | ||
N | 2251X0800X | Physical Therapist - Orthopedic | LPT09645 | OH |
NPI | 1366428518 |
---|---|
Provider Name | Amy J Patrick-Melin |
First Address | Ravenna, OH 44266-3218 |
Second Address | Cleveland, OH 44114 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/12/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
PT09645 | OHIO OT PT ATC BOARD (01) | OH |