Provider Demographics
NPI:1740807049
Name:SHOTT, MELISSA LYNN (PTA)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:LYNN
Last Name:SHOTT
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 1:59 DUDLEY CIR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27703-5823
Mailing Address - Country:US
Mailing Address - Phone:919-641-8559
Mailing Address - Fax:
Practice Address - Street 1:1071 PEMBERTON HILL RD
Practice Address - Street 2:
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27502-0080
Practice Address - Country:US
Practice Address - Phone:919-656-8734
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-02
Last Update Date:2020-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA4882225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant