Provider Demographics
NPI:1396038337
Name:TAIT, MELISSA (PT)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:TAIT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1001 ESTATE ROSS
Mailing Address - Street 2:STE 6
Mailing Address - City:ST THOMAS
Mailing Address - State:VI
Mailing Address - Zip Code:00802-4601
Mailing Address - Country:US
Mailing Address - Phone:340-779-4678
Mailing Address - Fax:866-648-2739
Practice Address - Street 1:350 S GREENLEAF ST
Practice Address - Street 2:SUITE 405
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-5709
Practice Address - Country:US
Practice Address - Phone:847-596-7640
Practice Address - Fax:847-596-7641
Is Sole Proprietor?:No
Enumeration Date:2011-05-24
Last Update Date:2021-10-14
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist