Provider Demographics
NPI:1821005224
Name:HATFIELD, MELISSA (CNMT, NCTMB, CMMMT)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:
Last Name:HATFIELD
Suffix:
Gender:F
Credentials:CNMT, NCTMB, CMMMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 E STRAWBRIDGE AVE STE B
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-4905
Mailing Address - Country:US
Mailing Address - Phone:321-951-3232
Mailing Address - Fax:
Practice Address - Street 1:550 E STRAWBRIDGE AVE STE B
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-4905
Practice Address - Country:US
Practice Address - Phone:321-951-3232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA35011208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMA35011OtherSTATE LICENSE
FLC1835OtherBLUE CROSS/BLUE SHIELD