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General NPI Number Information
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NPI Number | 1093215998
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Entity Type | Individual
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Provider Name | MELODIE BLAKELY DPT, CWS
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Gender | Female
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Dates
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Enumeration Date | 02/16/2018
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Last Update Date | 02/16/2018
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Provider Practice Location Address
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Address Line | 6200 LEE VISTA BLVD STE 250
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City | ORLANDO
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State | FL
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Zip | 32822-5104
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Country | US
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Telephone | 407-240-3996
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Fax | 866-845-1899
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Provider Business Mailing Address
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Address Line | 719 LAKE HIGHLAND DR
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City | ORLANDO
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State | FL
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Zip | 32803-2509
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Country | US
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Telephone | 206-355-7957
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT14736
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License Number State | FL
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