Healthcare Provider Details

I. General information

NPI: 1487283198
Provider Name (Legal Business Name): MELISSA HERBERT PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2020
Last Update Date: 04/04/2020
Certification Date: 04/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7045 EVERGREEN WOODS TRL
SPRING HILL FL
34608-1306
US

IV. Provider business mailing address

1169 CHANNING AVE
SPRING HILL FL
34608-6109
US

V. Phone/Fax

Practice location:
  • Phone: 813-361-4688
  • Fax:
Mailing address:
  • Phone: 609-649-8699
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number29944
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: