Provider Demographics
NPI:1144587494
Name:EDWARDS, MELISSA ANNE (PTA)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:ANNE
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6272 MILLWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WARRENTON
Mailing Address - State:VA
Mailing Address - Zip Code:20187-7924
Mailing Address - Country:US
Mailing Address - Phone:540-270-5859
Mailing Address - Fax:
Practice Address - Street 1:6272 MILLWOOD DR
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:VA
Practice Address - Zip Code:20187-7924
Practice Address - Country:US
Practice Address - Phone:540-270-5859
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-11
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2306601365225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant