Provider Demographics
NPI:1639877467
Name:AULT, MELISSA KAY (PTA)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:KAY
Last Name:AULT
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:KAY
Other - Last Name:DALEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:5770 N EDINBURG RD
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16116-3804
Mailing Address - Country:US
Mailing Address - Phone:724-651-0440
Mailing Address - Fax:
Practice Address - Street 1:174 VIRGINIA AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:PA
Practice Address - Zip Code:15074-1785
Practice Address - Country:US
Practice Address - Phone:724-775-6400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-21
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATEI002211225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant