Provider Demographics
NPI:1225668676
Name:MAILAND, MELISSA (PT, DPT)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:MAILAND
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14233 US HIGHWAY 27
Mailing Address - Street 2:
Mailing Address - City:HOAGLAND
Mailing Address - State:IN
Mailing Address - Zip Code:46745-9721
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14233 US HIGHWAY 27
Practice Address - Street 2:
Practice Address - City:HOAGLAND
Practice Address - State:IN
Practice Address - Zip Code:46745-9721
Practice Address - Country:US
Practice Address - Phone:260-449-0788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-23
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist