Provider Demographics
NPI:1851754527
Name:PAULSON, MELISSA (PT)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:PAULSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1640 W REDSTONE CENTER DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PARK CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84098
Mailing Address - Country:US
Mailing Address - Phone:850-681-0080
Mailing Address - Fax:
Practice Address - Street 1:4200 W CYPRESS ST
Practice Address - Street 2:SUITE 630
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-4156
Practice Address - Country:US
Practice Address - Phone:866-990-8880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-31
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 31222225100000X
NC3986225100000X
VA2305004044225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist