Healthcare Provider Details

I. General information

NPI: 1962990150
Provider Name (Legal Business Name): MELANIE ANN HUX LAT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2018
Last Update Date: 09/10/2020
Certification Date: 09/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 KINGS WAY STE 2700
WILLIAMSBURG VA
23185-2554
US

IV. Provider business mailing address

21 DOROTHY DR
POQUOSON VA
23662-1201
US

V. Phone/Fax

Practice location:
  • Phone: 757-221-0110
  • Fax:
Mailing address:
  • Phone: 757-848-6749
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: