Provider Demographics
NPI:1629471453
Name:HUTZELL, MELISSA RENE (ATC, MS)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:RENE
Last Name:HUTZELL
Suffix:
Gender:F
Credentials:ATC, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2943 BOUNDARY ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92104-5206
Mailing Address - Country:US
Mailing Address - Phone:209-401-5717
Mailing Address - Fax:
Practice Address - Street 1:1 PANTHER WAY
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92084-3128
Practice Address - Country:US
Practice Address - Phone:760-726-5611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-07
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer