Provider Demographics
NPI:1528392420
Name:BAUSE, MELISSA ANN (DPT)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANN
Last Name:BAUSE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4545 ASHMORE CIR NE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-1615
Mailing Address - Country:US
Mailing Address - Phone:770-630-1773
Mailing Address - Fax:
Practice Address - Street 1:310 PAPER TRAIL WAY
Practice Address - Street 2:SUITE 302
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30115-5203
Practice Address - Country:US
Practice Address - Phone:770-345-2804
Practice Address - Fax:678-827-0927
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-24
Last Update Date:2009-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT009687225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist