Healthcare Provider Details

I. General information

NPI: 1144570169
Provider Name (Legal Business Name): MELISSA NEWMAN PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2012
Last Update Date: 09/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14785 OLD SAINT AUGUSTINE RD
JACKSONVILLE FL
32258-2496
US

IV. Provider business mailing address

10200 BELLE RIVE BLVD UNIT 3601
JACKSONVILLE FL
32256-9649
US

V. Phone/Fax

Practice location:
  • Phone: 904-292-1808
  • Fax:
Mailing address:
  • Phone: 941-286-5955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number27487
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: