Provider Demographics
NPI:1649212622
Name:MELTON, JOHN PAUL (RPT)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:PAUL
Last Name:MELTON
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2225 HERON CIR
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33762-2251
Mailing Address - Country:US
Mailing Address - Phone:727-571-3091
Mailing Address - Fax:727-531-4799
Practice Address - Street 1:13787 BELCHER RD S
Practice Address - Street 2:STE 140
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33771-4065
Practice Address - Country:US
Practice Address - Phone:727-531-4700
Practice Address - Fax:727-531-4799
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFL413225100000X
NC3681225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY0031Medicare ID - Type Unspecified