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NPI Code Detail

MEDICARE: MELISSA GLUCKMAN PT

MEDICARE:   MELISSA  GLUCKMAN  PT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical TherapistPT 9322FL

General Provider Information

NPI Number : 1013212216
Entity Type Code : Individual
Provider Name (Legal Business Name) : MELISSA GLUCKMAN PT
Provider Business Mailing Address
First Line : 1020 MOJAVE TRL
Second Line :
City : MAITLAND
State : FL
Zip : 32751-3706
Country : US
Telephone Number : 407-956-1004
Fax Number : 407-956-1005
Provider Business Practice Location Address
First Line : 2071 DUNDEE DR
Second Line :
City : WINTER PARK
State : FL
Zip : 32792-4104
Country : US
Telephone Number : 407-628-4188
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/19/2011
Last Update Date : 02/17/2014

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