Provider Demographics
NPI:1922192152
Name:AMATO, MELISSA KELLY (DPT)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:KELLY
Last Name:AMATO
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MS
Other - First Name:MELISSA
Other - Middle Name:KELLY
Other - Last Name:DETZNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:2695 ROCKY MOUNTAIN AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-9071
Mailing Address - Country:US
Mailing Address - Phone:970-624-4128
Mailing Address - Fax:970-490-4340
Practice Address - Street 1:200 LINCOLN AVE UNIT 771211
Practice Address - Street 2:
Practice Address - City:STEAMBOAT SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80477-6648
Practice Address - Country:US
Practice Address - Phone:970-457-1191
Practice Address - Fax:970-871-2378
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9006225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO066581Medicare PIN