Healthcare Provider Details

I. General information

NPI: 1790982049
Provider Name (Legal Business Name): MELISSA MICHAEL PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 S SOUDER AVE
COLUMBUS OH
43222-1539
US

IV. Provider business mailing address

7556 JENKINS DR
CANAL WINCHESTER OH
43110-8381
US

V. Phone/Fax

Practice location:
  • Phone: 614-228-5900
  • Fax: 614-228-3989
Mailing address:
  • Phone: 614-829-2300
  • Fax: 614-829-2300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA6285
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: