Provider Demographics
NPI:1710141304
Name:BECK, MELISSA D (PTA)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:D
Last Name:BECK
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7600 AIRWAYS BLVD STE A
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38671-5138
Mailing Address - Country:US
Mailing Address - Phone:662-536-4096
Mailing Address - Fax:662-536-4099
Practice Address - Street 1:7600 AIRWAYS BLVD STE A
Practice Address - Street 2:SUITE 2
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671-5138
Practice Address - Country:US
Practice Address - Phone:662-536-4096
Practice Address - Fax:662-536-4099
Is Sole Proprietor?:No
Enumeration Date:2008-07-14
Last Update Date:2010-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT4650225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant