Healthcare Provider Details

I. General information

NPI: 1528226628
Provider Name (Legal Business Name): MELISSA JOY MCLAUCHLIN MPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2008
Last Update Date: 05/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 PRUDENTIAL DR HOWARD 6 SUITE 612
JACKSONVILLE FL
32207-8202
US

IV. Provider business mailing address

800 PRUDENTIAL DR HOWARD 6 SUITE 612
JACKSONVILLE FL
32207-8202
US

V. Phone/Fax

Practice location:
  • Phone: 904-202-2037
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number32606
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: