MEDICARE: MELYSSA LIBERTY LMT

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	225700000X	Massage Therapist	MT036442	TX

General Provider Information

NPI Number	:	1558233486
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELYSSA LIBERTY LMT

Provider Business Mailing Address
First Line	:	5326 COUNTY ROAD 73 APT B
Second Line	:
City	:	ROBSTOWN
State	:	TX
Zip	:	78380-5980
Country	:	US
Telephone Number	:	512-699-2777
Fax Number	:

Provider Business Practice Location Address
First Line	:	4303 CALLICOATTE RD
Second Line	:
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78410-3915
Country	:	US
Telephone Number	:	361-261-5261
Fax Number	:

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

Provider Enumeration Date	:	09/20/2025
Last Update Date	:	09/20/2025

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