Provider Demographics
NPI:1518110758
Name:THOMAS, MELISSA ANN (MPT)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANN
Last Name:THOMAS
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:158 1ST ST
Mailing Address - Street 2:
Mailing Address - City:ESTES PARK
Mailing Address - State:CO
Mailing Address - Zip Code:80517-6354
Mailing Address - Country:US
Mailing Address - Phone:970-577-0174
Mailing Address - Fax:970-577-0143
Practice Address - Street 1:158 1ST ST
Practice Address - Street 2:
Practice Address - City:ESTES PARK
Practice Address - State:CO
Practice Address - Zip Code:80517-6354
Practice Address - Country:US
Practice Address - Phone:970-577-0174
Practice Address - Fax:970-577-0143
Is Sole Proprietor?:No
Enumeration Date:2008-10-31
Last Update Date:2008-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO8160225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist