Healthcare Provider Details

I. General information

NPI: 1912334459
Provider Name (Legal Business Name): MELISSA RENEE EMRICK PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2013
Last Update Date: 06/10/2024
Certification Date: 06/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 N MICHIGAN AVE
COLDWATER MI
49036-1527
US

IV. Provider business mailing address

90 N MICHIGAN AVE
COLDWATER MI
49036-1527
US

V. Phone/Fax

Practice location:
  • Phone: 517-279-9808
  • Fax: 517-278-0009
Mailing address:
  • Phone: 517-279-9808
  • Fax: 517-278-0009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number5502003942
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: