Provider Demographics
NPI:1538478953
Name:MELITO, LAUREN MARIE (DPT)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:MARIE
Last Name:MELITO
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:PO BOX 2699
Mailing Address - Street 2:SHMG/HPE
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32513-2699
Mailing Address - Country:US
Mailing Address - Phone:850-235-6360
Mailing Address - Fax:850-235-8871
Practice Address - Street 1:120 N RICHARD JACKSON BLVD
Practice Address - Street 2:STE 130
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32407-2521
Practice Address - Country:US
Practice Address - Phone:850-235-6360
Practice Address - Fax:850-235-8871
Is Sole Proprietor?:No
Enumeration Date:2010-10-04
Last Update Date:2013-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT27421225100000X
MD23338225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPT27421OtherPHYSICAL THERAPIST LICENSE