Provider Demographics
NPI:1114214764
Name:DUKES, MELISSA BELLE (LPTA)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:BELLE
Last Name:DUKES
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1705 DR MARTIN LUTHER KING JR MEM RD
Mailing Address - Street 2:
Mailing Address - City:CRAWFORDVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32327-3667
Mailing Address - Country:US
Mailing Address - Phone:850-508-9936
Mailing Address - Fax:
Practice Address - Street 1:1705 DR MARTIN LUTHER KING JR MEM RD
Practice Address - Street 2:
Practice Address - City:CRAWFORDVILLE
Practice Address - State:FL
Practice Address - Zip Code:32327-3667
Practice Address - Country:US
Practice Address - Phone:850-508-9936
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-05
Last Update Date:2011-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA20537174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist