Provider Demographics
NPI:1629214531
Name:AIKSNORAS, MELISSA R (PT, DPT)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:R
Last Name:AIKSNORAS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:R
Other - Last Name:LACHANCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1200 CORPORATE DR STE 400
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-5424
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:
Practice Address - Street 1:5415 THOMPSON MILL RD
Practice Address - Street 2:
Practice Address - City:HOSCHTON
Practice Address - State:GA
Practice Address - Zip Code:30548-4132
Practice Address - Country:US
Practice Address - Phone:709-653-5087
Practice Address - Fax:770-965-3279
Is Sole Proprietor?:No
Enumeration Date:2008-12-23
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPT02197225100000X
MA18512225100000X
GAPT010748225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI001475501Medicare PIN