Provider Demographics
NPI:1851456800
Name:BLANK, MELISSA J (MPT)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:J
Last Name:BLANK
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12 TAVERNGREEN CT
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-5302
Mailing Address - Country:US
Mailing Address - Phone:410-602-3676
Mailing Address - Fax:410-938-8664
Practice Address - Street 1:2328 W JOPPA RD
Practice Address - Street 2:SUITE 300
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093-4612
Practice Address - Country:US
Practice Address - Phone:410-938-8660
Practice Address - Fax:410-938-8664
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD20047225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist