Provider Demographics
NPI:1689326555
Name:RODRIGUEZ, MELISSA MARIE WILKINS (LAT, ATC)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:MARIE WILKINS
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 GUN CLUB DR
Mailing Address - Street 2:
Mailing Address - City:PINEHURST
Mailing Address - State:NC
Mailing Address - Zip Code:28374-8022
Mailing Address - Country:US
Mailing Address - Phone:931-561-7829
Mailing Address - Fax:
Practice Address - Street 1:250 VOIT GILMORE RD
Practice Address - Street 2:
Practice Address - City:SOUTHERN PINES
Practice Address - State:NC
Practice Address - Zip Code:28387-4332
Practice Address - Country:US
Practice Address - Phone:910-692-6554
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-21
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLAT-46332255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer