Healthcare Provider Details

I. General information

NPI: 1194019885
Provider Name (Legal Business Name): MELISSA A HUTSON LPTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2011
Last Update Date: 05/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1908 OLDE HALEY DR
CENTERVILLE OH
45458-6083
US

IV. Provider business mailing address

1908 OLDE HALEY DR
CENTERVILLE OH
45458-6083
US

V. Phone/Fax

Practice location:
  • Phone: 330-498-8200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA. 5479
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: