Provider Demographics
NPI:1104192129
Name:MONACO, MELISSA CHRISTINE (LMT)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:CHRISTINE
Last Name:MONACO
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2122 SE 16TH ST
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33990-3815
Mailing Address - Country:US
Mailing Address - Phone:941-237-0645
Mailing Address - Fax:
Practice Address - Street 1:8981 DANIELS CENTER DR
Practice Address - Street 2:204
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-0306
Practice Address - Country:US
Practice Address - Phone:941-237-0645
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-23
Last Update Date:2012-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA56617225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist