Healthcare Provider Details

I. General information

NPI: 1467725671
Provider Name (Legal Business Name): MELISSA LYNN SACO-VERTIZ LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2012
Last Update Date: 02/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

241 SE 9TH AVE APT 106
POMPANO BEACH FL
33060-7336
US

IV. Provider business mailing address

241 SE 9TH AVE APT 106
POMPANO BEACH FL
33060-7336
US

V. Phone/Fax

Practice location:
  • Phone: 561-654-0007
  • Fax:
Mailing address:
  • Phone: 561-654-0007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172M00000X
TaxonomyMechanotherapist
License NumberMA61807
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: