Provider Demographics
NPI:1710520028
Name:HAMERA, MELISA M
Entity Type:Individual
Prefix:
First Name:MELISA
Middle Name:M
Last Name:HAMERA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MELISA
Other - Middle Name:M
Other - Last Name:KABILIZYA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3400 N LECANTO HWY STE B
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:FL
Mailing Address - Zip Code:34465-3548
Mailing Address - Country:US
Mailing Address - Phone:352-527-8489
Mailing Address - Fax:
Practice Address - Street 1:8751 W CHARLESTON BLVD STE 270
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-5497
Practice Address - Country:US
Practice Address - Phone:702-982-2232
Practice Address - Fax:702-982-2237
Is Sole Proprietor?:No
Enumeration Date:2019-10-21
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT34826225100000X
FL225100000X
2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist