Provider Demographics
NPI:1598157695
Name:KORATTIYIL, MELSON MATHEW (PT, DPT, MPH)
Entity Type:Individual
Prefix:
First Name:MELSON
Middle Name:MATHEW
Last Name:KORATTIYIL
Suffix:
Gender:M
Credentials:PT, DPT, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:932 OAKFIELD DR
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-4950
Mailing Address - Country:US
Mailing Address - Phone:813-654-1410
Mailing Address - Fax:
Practice Address - Street 1:932 OAKFIELD DR
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-4950
Practice Address - Country:US
Practice Address - Phone:813-654-1410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-26
Last Update Date:2015-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 30074225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist