Provider Demographics
NPI:1285672923
Name:TUTAS, MELISSA (MSPT)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:
Last Name:TUTAS
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 FARM VIEW DR
Mailing Address - Street 2:
Mailing Address - City:FALLSTON
Mailing Address - State:MD
Mailing Address - Zip Code:21047-1302
Mailing Address - Country:US
Mailing Address - Phone:443-414-7139
Mailing Address - Fax:410-941-5057
Practice Address - Street 1:3465 BOX HILL CORPORATE CENTER DR
Practice Address - Street 2:SUITE G
Practice Address - City:ABINGDON
Practice Address - State:MD
Practice Address - Zip Code:21009-1261
Practice Address - Country:US
Practice Address - Phone:410-569-4806
Practice Address - Fax:410-569-5474
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-03
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD19053225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD4842670001OtherDME POS ASSIGNED
MD522248150OtherCOVENTRY HEALTHCARE OF DE
MD522248150OtherINTEGRATED HAELTH PLAN
MD0007263155OtherAETNA
MD2144336OtherOPTIMUM CHOICE
MD650018560OtherRAILROAD MEDICARE
MD401764100Medicaid
MD51647OtherEHP, KAISER, PRIORITY PAR
MD522248150OtherTRICARE STANDARD
MD522248150OtherCIGNA
MDT121-0001OtherFED BCBS
MD2144336OtherALLIANCE
MD76934702OtherCAREFIRST BCBS RENDERING
MDT121-0001OtherBLUE CHOICE
MD350342400OtherOWCP