Healthcare Provider Details

I. General information

NPI: 1063642106
Provider Name (Legal Business Name): MELISSA KATHERINE RHUDE LPTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2009
Last Update Date: 07/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2802 PARENTAL HOME RD
JACKSONVILLE FL
32216-5702
US

IV. Provider business mailing address

14029 FORTUNADO RD
JACKSONVILLE FL
32225-2003
US

V. Phone/Fax

Practice location:
  • Phone: 904-721-0088
  • Fax:
Mailing address:
  • Phone: 904-221-7553
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA19688
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: