MEDICARE: DAVID R MELCHIONE MSPT

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	PT-25544	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	QY500	OTHER	FL	HFMG MA
2	Y07EY	OTHER	FL	FLORIDA BLUE
3	PT-25544	OTHER	FL	STATE OF FL. PT LICENSE

General Provider Information

NPI Number	:	1649379157
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID R MELCHIONE MSPT

Provider Business Mailing Address
First Line	:	3300 S FISKE BLVD
Second Line	:
City	:	ROCKLEDGE
State	:	FL
Zip	:	32955-4306
Country	:	US
Telephone Number	:	321-434-5820
Fax Number	:	321-434-5821

Provider Business Practice Location Address
First Line	:	220 S COURTENAY PKWY STE B
Second Line	:
City	:	MERRITT ISLAND
State	:	FL
Zip	:	32952-4893
Country	:	US
Telephone Number	:	321-434-5820
Fax Number	:	321-434-5821

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

Provider Enumeration Date	:	09/21/2006
Last Update Date	:	06/08/2023

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Directions to “ DAVID R MELCHIONE MSPT” Practice Location

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