Healthcare Provider Details

I. General information

NPI: 1477010643
Provider Name (Legal Business Name): MELISSA ANN SMITH LPTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2019
Last Update Date: 02/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 RORER ST
CHATHAM VA
24531-5455
US

IV. Provider business mailing address

1172 GAMMONS LAKE RD
CHATHAM VA
24531-4399
US

V. Phone/Fax

Practice location:
  • Phone: 434-432-0471
  • Fax:
Mailing address:
  • Phone: 434-251-2575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2306603055
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: