Provider Demographics
NPI:1033831656
Name:WILEY, MELISSA KUJAT (CEP)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:KUJAT
Last Name:WILEY
Suffix:
Gender:F
Credentials:CEP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2905 BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:COLONIAL HEIGHTS
Mailing Address - State:VA
Mailing Address - Zip Code:23834-2400
Mailing Address - Country:US
Mailing Address - Phone:804-524-2010
Mailing Address - Fax:
Practice Address - Street 1:2905 BOULEVARD
Practice Address - Street 2:
Practice Address - City:COLONIAL HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:23834-2400
Practice Address - Country:US
Practice Address - Phone:804-526-0682
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-12
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Y00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersClinical Exercise Physiologist