Provider Demographics
NPI:1942753272
Name:MELTON, JAMES LEE (DPT)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:LEE
Last Name:MELTON
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:554 TWIN CITIES BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:NICEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32578-1058
Mailing Address - Country:US
Mailing Address - Phone:850-729-3325
Mailing Address - Fax:850-729-2052
Practice Address - Street 1:554 TWIN CITIES BLVD STE A
Practice Address - Street 2:
Practice Address - City:NICEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32578-1058
Practice Address - Country:US
Practice Address - Phone:850-729-3325
Practice Address - Fax:850-729-2052
Is Sole Proprietor?:No
Enumeration Date:2016-08-03
Last Update Date:2016-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT31422225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist