Provider Demographics
NPI:1609198860
Name:HALE, MELISSA ETHEL (PT)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:ETHEL
Last Name:HALE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25046 MALVERN ST
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34601-4929
Mailing Address - Country:US
Mailing Address - Phone:813-690-6392
Mailing Address - Fax:
Practice Address - Street 1:10610 N 56TH ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33617-3641
Practice Address - Country:US
Practice Address - Phone:813-983-0440
Practice Address - Fax:813-983-8110
Is Sole Proprietor?:No
Enumeration Date:2010-02-15
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL23993225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist