Healthcare Provider Details

I. General information

NPI: 1740551720
Provider Name (Legal Business Name): MELISSA CAGE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELISSA GARCIA PTA

II. Dates (important events)

Enumeration Date: 01/23/2012
Last Update Date: 01/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5721 ANTIETAM DR
SARASOTA FL
34231-4903
US

IV. Provider business mailing address

5721 ANTIETAM DR
SARASOTA FL
34231-4903
US

V. Phone/Fax

Practice location:
  • Phone: 239-699-7574
  • Fax:
Mailing address:
  • Phone: 239-699-7574
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number19392
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: