Healthcare Provider Details

I. General information

NPI: 1699265710
Provider Name (Legal Business Name): MELANIE REZAIE PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2018
Last Update Date: 05/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2484 BRIARCLIFF RD NE STE 30
ATLANTA GA
30329-3011
US

IV. Provider business mailing address

1208 BRIARVISTA WAY NE
ATLANTA GA
30329-3630
US

V. Phone/Fax

Practice location:
  • Phone: 404-228-3678
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: