Provider Demographics
NPI:1073558961
Name:TENNANT, MELISSA L (PT)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:L
Last Name:TENNANT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:MELISSA
Other - Middle Name:L
Other - Last Name:WALDRON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1270 MONTEVUE LANE (AREA B)
Mailing Address - Street 2:
Mailing Address - City:FORT DETRICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702
Mailing Address - Country:US
Mailing Address - Phone:301-619-8607
Mailing Address - Fax:
Practice Address - Street 1:1434 PORTER ST
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-9254
Practice Address - Country:US
Practice Address - Phone:301-619-8607
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8644225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist