Provider Demographics
NPI:1740595776
Name:PHYSICAL THERAPY OF MELISSA, PLLC
Entity Type:Organization
Organization Name:PHYSICAL THERAPY OF MELISSA, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:NATHANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CHRISTADOSS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:972-837-4450
Mailing Address - Street 1:3201 MCKINNEY ST
Mailing Address - Street 2:
Mailing Address - City:MELISSA
Mailing Address - State:TX
Mailing Address - Zip Code:75454-9762
Mailing Address - Country:US
Mailing Address - Phone:972-837-4450
Mailing Address - Fax:972-837-4451
Practice Address - Street 1:3201 MCKINNEY ST
Practice Address - Street 2:
Practice Address - City:MELISSA
Practice Address - State:TX
Practice Address - Zip Code:75454-9762
Practice Address - Country:US
Practice Address - Phone:972-837-4450
Practice Address - Fax:972-837-4451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-14
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1169447261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB107962Medicare UPIN