Healthcare Provider Details

I. General information

NPI: 1306847959
Provider Name (Legal Business Name): MELISSA ANN LAFOLLETTE PT MT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELISSA ANN JOHNSON PT MT

II. Dates (important events)

Enumeration Date: 08/04/2005
Last Update Date: 05/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4440 GLEN ESTE WITHAMSVILLE RD
CINCINNATI OH
45245-1318
US

IV. Provider business mailing address

4701 CREEK RD SUITE 110
CINCINNATI OH
45242-8398
US

V. Phone/Fax

Practice location:
  • Phone: 513-943-3630
  • Fax: 513-753-4308
Mailing address:
  • Phone: 513-733-9333
  • Fax: 513-588-2479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number33.013454
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT.009877
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: