Melissa D Edmondson, PT
Individual provider Active NPI Physical Therapist · Socorro, NM
NPI 1376987461 · NPPES record last updated Apr 19, 2013
Key facts
- NPI
- 1376987461
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 4287 (NM)
- Practice address
- 1204 Highway 60
Socorro, NM 87801-3914 - Phone
- (575) 838-4690
- Fax
- (575) 838-4689
- NPI assigned
- Apr 19, 2013
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Physical Therapist in Private Practice
- Education
- Other, 1993
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Positive Outcomes Inc
Practice addresses (Care Compare)
1115 N California St
Socorro, NM 87801-4265
Phone (575) 838-0800
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NM
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20210209001618 | NM | Practitioner - Physical Therapist in Private Practice | 7113332966 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4287 | NM | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Positive Outcomes, Inc. | Physical Therapist | Current |
Accepting new patients |
Locations
1115 N California St
Socorro, NM 87801
Phone (505) 838-1100
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 4287 | NM | Yes |
Addresses
Primary practice location
1204 Highway 60
Socorro, NM 87801-3914
Mailing address
1204 Highway 60
Socorro, NM 87801-3914
Phone (575) 838-4690
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4287 | Other | NM | NM STATE LICENSE |
Other providers in Socorro, NM
- Lianna Nicole Dibartolomeo
- Jeanne Mary Dixon
- Coyle John Domina
- Michelle Duggins
- Raudel Duron
- Eei, LLC
- Elite Dental LLC
- Enchantment Home Health MGMT
- Naomi Mae Erives
- Chama Etheridge
All providers in Socorro, NM · Physical Therapist in New Mexico
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 19, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.