Healthcare Provider Details

I. General information

NPI: 1205377967
Provider Name (Legal Business Name): MELISSA ANN WHITE PT, DPT, COMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELISSA ANN WATERS PT, DPT, COMT

II. Dates (important events)

Enumeration Date: 03/14/2017
Last Update Date: 03/17/2023
Certification Date: 03/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 FLORAL VALE BLVD
YARDLEY PA
19067-5522
US

IV. Provider business mailing address

103 FLORAL VALE BLVD
YARDLEY PA
19067-5522
US

V. Phone/Fax

Practice location:
  • Phone: 215-860-4270
  • Fax:
Mailing address:
  • Phone: 215-860-4270
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT003658
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number10518
License Number StateMN
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT027559
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: