Provider Demographics
NPI:1922392075
Name:PAGE, MELODY (LMT)
Entity Type:Individual
Prefix:MS
First Name:MELODY
Middle Name:
Last Name:PAGE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 W PLUMOSA LN
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467-4836
Mailing Address - Country:US
Mailing Address - Phone:561-676-6892
Mailing Address - Fax:
Practice Address - Street 1:6620 LAKE WORTH RD
Practice Address - Street 2:UNIT C
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33467-1518
Practice Address - Country:US
Practice Address - Phone:561-676-6892
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-07
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA62355172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist