Basic Information
| Provider Information | |||||||||
| NPI: | 1932343803 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KILLAM | ||||||||
| FirstName: | MELANIE | ||||||||
| MiddleName: | SHOWALTER | ||||||||
| NamePrefix: | MRS. | ||||||||
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| OtherLastName: | SHOWALTER | ||||||||
| OtherFirstName: | MELANIE | ||||||||
| OtherMiddleName: | SUE | ||||||||
| OtherNamePrefix: | MISS | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 245 CAHABA VALLEY PKWY | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | PELHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 351242216 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2059426820 | ||||||||
| FaxNumber: | 2059425884 | ||||||||
| Practice Location | |||||||||
| Address1: | 715 EAST LAUREL STREET | ||||||||
| Address2: | ATMORE NURSING CENTER | ||||||||
| City: | ATMORE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 36502 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2513689121 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/23/2009 | ||||||||
| LastUpdateDate: | 04/23/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 1987 | AL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | 7117 | FL | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.