Provider Demographics
NPI:1619458049
Name:SOTO, MELISSA (PTA)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:SOTO
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 1:14704 JONATHAN ST
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79118-2035
Mailing Address - Country:US
Mailing Address - Phone:806-670-2655
Mailing Address - Fax:
Practice Address - Street 1:405 COLLINS ST
Practice Address - Street 2:
Practice Address - City:CLAUDE
Practice Address - State:TX
Practice Address - Zip Code:79019
Practice Address - Country:US
Practice Address - Phone:866-531-1033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-23
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2087773208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation