Provider Demographics
NPI:1558489484
Name:HORNE, MELISSA KAY (CMT)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:KAY
Last Name:HORNE
Suffix:
Gender:F
Credentials:CMT
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 333
Mailing Address - Street 2:1258 WHITETAIL ROAD
Mailing Address - City:OAKWOOD
Mailing Address - State:VA
Mailing Address - Zip Code:24631-0333
Mailing Address - Country:US
Mailing Address - Phone:276-498-1186
Mailing Address - Fax:
Practice Address - Street 1:1779 LOVERS GAP ROAD
Practice Address - Street 2:
Practice Address - City:VANSANT
Practice Address - State:VA
Practice Address - Zip Code:24656
Practice Address - Country:US
Practice Address - Phone:276-597-8387
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019004337225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist