Provider Demographics
NPI:1699029314
Name:REIMERT, MELISSA ANN (PT, OTR/L, DPT, MOT)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANN
Last Name:REIMERT
Suffix:
Gender:F
Credentials:PT, OTR/L, DPT, MOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26204 HARBOUR VISTA CIR
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32080-5130
Mailing Address - Country:US
Mailing Address - Phone:540-560-3534
Mailing Address - Fax:
Practice Address - Street 1:26204 HARBOUR VISTA CIR
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32080-5130
Practice Address - Country:US
Practice Address - Phone:540-560-3534
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-02
Last Update Date:2014-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT28929225100000X
FLOT15432225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist