Healthcare Provider Details

I. General information

NPI: 1558489484
Provider Name (Legal Business Name): MELISSA KAY HORNE CMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1779 LOVERS GAP ROAD
VANSANT VA
24656
US

IV. Provider business mailing address

PO BOX 333 1258 WHITETAIL ROAD
OAKWOOD VA
24631-0333
US

V. Phone/Fax

Practice location:
  • Phone: 276-597-8387
  • Fax:
Mailing address:
  • Phone: 276-498-1186
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number0019004337
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: