Provider Demographics
NPI:1710312202
Name:FAROTTO, MELANIE SANDY (PT)
Entity Type:Individual
Prefix:MRS
First Name:MELANIE
Middle Name:SANDY
Last Name:FAROTTO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8514 POYDRAS LN
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33635-1610
Mailing Address - Country:US
Mailing Address - Phone:813-417-3360
Mailing Address - Fax:
Practice Address - Street 1:13139 W LINEBAUGH AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33626-4498
Practice Address - Country:US
Practice Address - Phone:813-932-3013
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-04
Last Update Date:2013-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT4447225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL885154900Medicaid