Provider Demographics
NPI:1629323019
Name:KING, MELISSA DAWN (LMT)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:DAWN
Last Name:KING
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8109 COOPER CREEK BLVD
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY PARK
Mailing Address - State:FL
Mailing Address - Zip Code:34201-2004
Mailing Address - Country:US
Mailing Address - Phone:941-366-1168
Mailing Address - Fax:
Practice Address - Street 1:8109 COOPER CREEK BLVD
Practice Address - Street 2:
Practice Address - City:UNIVERSITY PARK
Practice Address - State:FL
Practice Address - Zip Code:34201-2004
Practice Address - Country:US
Practice Address - Phone:941-366-1168
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-21
Last Update Date:2012-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA63119225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist