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General NPI Number Information
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NPI Number | 1598219917
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Entity Type | Individual
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Provider Name | MELISSA ANN MIXSON PTA
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Gender | Female
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Dates
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Enumeration Date | 08/15/2016
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Last Update Date | 08/15/2016
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Provider Practice Location Address
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Address Line | 1445 HOWELL AVE
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City | BROOKSVILLE
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State | FL
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Zip | 34601-1502
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Country | US
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Telephone | 352-799-1451
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Fax |
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Provider Business Mailing Address
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Address Line | 4280 BISCAYNE DR
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City | HERNANDO BEACH
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State | FL
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Zip | 34607-3003
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Country | US
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Telephone | 352-442-8358
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | PTA26728
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License Number State | FL
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