Provider Demographics
NPI:1578950176
Name:FRIXIONE, MELISSA NICOLE (LAT, ATC)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:NICOLE
Last Name:FRIXIONE
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8281 WALKER ST
Mailing Address - Street 2:
Mailing Address - City:LA PALMA
Mailing Address - State:CA
Mailing Address - Zip Code:90623-2123
Mailing Address - Country:US
Mailing Address - Phone:661-965-6847
Mailing Address - Fax:
Practice Address - Street 1:GEORGE ALBERT SMITH FIELDHOUSE
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604
Practice Address - Country:US
Practice Address - Phone:661-965-6847
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9489396-48102255A2300X
2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer