Provider Demographics
NPI:1669021416
Name:TATE, MELISSA MARIE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:MARIE
Last Name:TATE
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2720 WESTERN CENTER BLVD STE 312
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76131-4302
Mailing Address - Country:US
Mailing Address - Phone:817-847-0200
Mailing Address - Fax:
Practice Address - Street 1:2720 WESTERN CENTER BLVD STE 312
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76131-4302
Practice Address - Country:US
Practice Address - Phone:817-847-0200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-04
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1322909225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist