Healthcare Provider Details

I. General information

NPI: 1932474269
Provider Name (Legal Business Name): MELISSA JANE ROBERTS LPTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2012
Last Update Date: 03/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 WIMBLEDON SQ
CHESAPEAKE VA
23320-4931
US

IV. Provider business mailing address

1340 BARBARA CT
CHESAPEAKE VA
23322-2708
US

V. Phone/Fax

Practice location:
  • Phone: 757-547-5145
  • Fax:
Mailing address:
  • Phone: 757-421-2682
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2306602689
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: