Provider Demographics
NPI:1376886754
Name:SERVEDIO, MELISSA ANN
Entity Type:Individual
Prefix:MISS
First Name:MELISSA
Middle Name:ANN
Last Name:SERVEDIO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 JUNIPER LEAF WAY
Mailing Address - Street 2:
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29651-3942
Mailing Address - Country:US
Mailing Address - Phone:864-360-4584
Mailing Address - Fax:
Practice Address - Street 1:210 JUNIPER LEAF WAY
Practice Address - Street 2:
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29651-3942
Practice Address - Country:US
Practice Address - Phone:864-360-4584
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-03
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC526225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant