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General NPI Number Information
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NPI Number | 1598099285
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Entity Type | Individual
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Provider Name | JUSTIN MELANSON MS, ATC, LAT, CSCS
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Gender | Male
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Dates
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Enumeration Date | 09/28/2009
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Last Update Date | 09/28/2009
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Provider Practice Location Address
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Address Line | 7300 PERRY CREEK RD
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City | RALEIGH
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State | NC
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Zip | 27616-6440
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Country | US
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Telephone | 919-573-1631
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Fax | 919-573-7901
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Provider Business Mailing Address
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Address Line | 7300 PERRY CREEK RD
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City | RALEIGH
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State | NC
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Zip | 27616-6440
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Country | US
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Telephone | 919-573-1631
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Fax | 919-573-7901
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 1571
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License Number State | NC
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