Provider Demographics
NPI:1114431970
Name:FREEMAN, MELISSA TODD (ATC)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:TODD
Last Name:FREEMAN
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2092 BROOKSTONE DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT JULIET
Mailing Address - State:TN
Mailing Address - Zip Code:37122-3279
Mailing Address - Country:US
Mailing Address - Phone:615-406-6776
Mailing Address - Fax:
Practice Address - Street 1:735 N MOUNT JULIET RD
Practice Address - Street 2:
Practice Address - City:MOUNT JULIET
Practice Address - State:TN
Practice Address - Zip Code:37122-3399
Practice Address - Country:US
Practice Address - Phone:615-406-6776
Practice Address - Fax:615-406-6776
Is Sole Proprietor?:No
Enumeration Date:2017-11-30
Last Update Date:2017-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN00000001412255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer