Provider Demographics
NPI:1134574916
Name:HART, MELISSA (LMT)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:HART
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:REED
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2119 WESTMEAD DR SW STE 8
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35603-1088
Mailing Address - Country:US
Mailing Address - Phone:256-822-2215
Mailing Address - Fax:
Practice Address - Street 1:2119 WESTMEAD DR SW STE 8
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35603-1088
Practice Address - Country:US
Practice Address - Phone:256-822-2215
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-28
Last Update Date:2018-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4456225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist