Provider Demographics
NPI:1659450088
Name:PLATT, MELISSA ANN (MSPT)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANN
Last Name:PLATT
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:919 ADDERLY LN
Mailing Address - Street 2:
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-4755
Mailing Address - Country:US
Mailing Address - Phone:847-980-3791
Mailing Address - Fax:847-573-0129
Practice Address - Street 1:919 ADDERLY LN
Practice Address - Street 2:
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-4755
Practice Address - Country:US
Practice Address - Phone:847-980-3791
Practice Address - Fax:847-573-0129
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist