Healthcare Provider Details

I. General information

NPI: 1053523795
Provider Name (Legal Business Name): MELISSA CARR PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2210 HIGHWAY 44 W
INVERNESS FL
34453-3860
US

IV. Provider business mailing address

2210 HIGHWAY 44 W
INVERNESS FL
34453-3860
US

V. Phone/Fax

Practice location:
  • Phone: 352-860-2220
  • Fax: 352-860-1181
Mailing address:
  • Phone: 352-860-2220
  • Fax: 352-860-1181

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA19028
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: