Provider Demographics
NPI:1619189370
Name:HALL, MELISSA S (PTA)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:S
Last Name:HALL
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:683 AUTUMN DR
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:OH
Mailing Address - Zip Code:44001-2401
Mailing Address - Country:US
Mailing Address - Phone:440-984-2025
Mailing Address - Fax:
Practice Address - Street 1:3364 KOLBE RD
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44053-1628
Practice Address - Country:US
Practice Address - Phone:440-282-2244
Practice Address - Fax:440-282-7709
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6033225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant