Provider Demographics
NPI:1538702311
Name:TOUBOL, MELISSA (CEAS)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:TOUBOL
Suffix:
Gender:F
Credentials:CEAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1093 E BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:CO
Mailing Address - Zip Code:80601-2252
Mailing Address - Country:US
Mailing Address - Phone:720-716-4518
Mailing Address - Fax:833-971-1890
Practice Address - Street 1:695 S BROADWAY ST
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80305-5969
Practice Address - Country:US
Practice Address - Phone:303-402-9283
Practice Address - Fax:833-906-2610
Is Sole Proprietor?:No
Enumeration Date:2019-10-23
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant