=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316278864
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MELISSA A MAHER DC PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/22/2010
-----------------------------------------------------
Last Update Date | 07/07/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2202 W ATLANTIC AVE
-----------------------------------------------------
City | DELRAY BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33445-4669
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-894-7010
-----------------------------------------------------
Fax | 561-270-2721
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 16244 S MILITARY TRL STE 460
-----------------------------------------------------
City | DELRAY BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33484-6532
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-894-7010
-----------------------------------------------------
Fax | 561-270-2721
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VP
-----------------------------------------------------
Name | MR. STEVEN S MAHER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 561-894-7010
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | PT19642
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | CH8601
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------