Healthcare Provider Details

I. General information

NPI: 1558443036
Provider Name (Legal Business Name): MELISSA MCINNIS EBERLIN PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MELISSA LEE MCINNIS PT

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 11/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

698 MORRISON RD
COLUMBUS OH
43213-4419
US

IV. Provider business mailing address

698 MORRISON RD
COLUMBUS OH
43213-4419
US

V. Phone/Fax

Practice location:
  • Phone: 614-868-1115
  • Fax: 614-863-9338
Mailing address:
  • Phone: 614-868-1115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT 012610
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: