Provider Demographics
NPI:1235569542
Name:NOETH, MELISSA ADA (DPT)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:ADA
Last Name:NOETH
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:ADA
Other - Last Name:HULL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:520 PALM COAST PKWY SW
Mailing Address - Street 2:STE 101
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32137-4743
Mailing Address - Country:US
Mailing Address - Phone:858-966-5406
Mailing Address - Fax:858-966-5859
Practice Address - Street 1:520 PALM COAST PKWY SW
Practice Address - Street 2:STE 101
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-4743
Practice Address - Country:US
Practice Address - Phone:386-446-4101
Practice Address - Fax:386-447-2161
Is Sole Proprietor?:No
Enumeration Date:2013-11-22
Last Update Date:2020-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL26180225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist