MEDICARE: MELISSA SUE COBB DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1114532447
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA SUE COBB DPT

Provider Business Mailing Address
First Line	:	1240 W GRANADA BLVD STE 1
Second Line	:
City	:	ORMOND BEACH
State	:	FL
Zip	:	32174-6020
Country	:	US
Telephone Number	:	386-898-0220
Fax Number	:

Provider Business Practice Location Address
First Line	:	1240 W GRANADA BLVD STE 1
Second Line	:
City	:	ORMOND BEACH
State	:	FL
Zip	:	32174-6020
Country	:	US
Telephone Number	:	386-898-0220
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/14/2020
Last Update Date	:	04/10/2026

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