MEDICARE: MR. JOHN PAUL MELTON RPT

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
1	225100000X	Physical Therapist	FL413	FL
2	225100000X	Physical Therapist	3681	NC

General Provider Information

NPI Number	:	1649212622
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOHN PAUL MELTON RPT

Provider Business Mailing Address
First Line	:	2225 HERON CIR
Second Line	:
City	:	CLEARWATER
State	:	FL
Zip	:	33762-2251
Country	:	US
Telephone Number	:	727-571-3091
Fax Number	:	727-531-4799

Provider Business Practice Location Address
First Line	:	13787 BELCHER RD S
Second Line	:	STE 140
City	:	LARGO
State	:	FL
Zip	:	33771-4065
Country	:	US
Telephone Number	:	727-531-4700
Fax Number	:	727-531-4799

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/12/2006
Last Update Date	:	07/08/2007

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