MEDICARE: MRS. MELISA MAISEL CLINE PT

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	1115244	TX

General Provider Information

NPI Number	:	1780651257
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MELISA MAISEL CLINE PT

Provider Business Mailing Address
First Line	:	1660 W RANDOL MILL RD
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76012-3035
Country	:	US
Telephone Number	:	817-461-4257
Fax Number	:	817-461-4865

Provider Business Practice Location Address
First Line	:	1660 W RANDOL MILL RD
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76012-3035
Country	:	US
Telephone Number	:	817-461-4257
Fax Number	:	817-461-4865

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

Provider Enumeration Date	:	03/03/2006
Last Update Date	:	03/27/2008

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