Provider Demographics
NPI:1316221476
Name:AVERSA, MELISSA (DPT, OTC, CSCS)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:
Last Name:AVERSA
Suffix:
Gender:F
Credentials:DPT, OTC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7171 N UNIVERSITY DR STE 111
Mailing Address - Street 2:
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-2902
Mailing Address - Country:US
Mailing Address - Phone:954-722-9992
Mailing Address - Fax:954-597-7773
Practice Address - Street 1:7171 N UNIVERSITY DR STE 111
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-2902
Practice Address - Country:US
Practice Address - Phone:954-722-9992
Practice Address - Fax:954-597-7773
Is Sole Proprietor?:No
Enumeration Date:2011-10-06
Last Update Date:2021-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL26621225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist