Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 5372 | MS |
NPI | 1003225400 |
---|---|
Provider Name | Dr. Melanie Mcdonald |
First Address | Hattiesburg, MS 39402-1567 |
Second Address | Hattiesburg, MS 39401-7230 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2014 |
Last Update Date | 11/08/2014 |