Provider Demographics
NPI:1508235094
Name:MELVIN, CASSIE (PTA)
Entity Type:Individual
Prefix:
First Name:CASSIE
Middle Name:
Last Name:MELVIN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1875 PRESIDENTIAL HTS APT 1122
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80905-8323
Mailing Address - Country:US
Mailing Address - Phone:678-414-6620
Mailing Address - Fax:
Practice Address - Street 1:1875 PRESIDENTIAL HTS APT 1122
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80905-8323
Practice Address - Country:US
Practice Address - Phone:678-414-6620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-15
Last Update Date:2015-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0013629225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant