Provider Demographics
NPI:1205213030
Name:LAWLESS, MELISSA LYNN (PT, DPT)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:LYNN
Last Name:LAWLESS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:LYNN
Other - Last Name:SPURBECK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:1650 LYNDON FARM CT STE 300
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-5005
Mailing Address - Country:US
Mailing Address - Phone:304-917-3660
Mailing Address - Fax:304-917-3674
Practice Address - Street 1:10430 STATE ROUTE 550 STE A
Practice Address - Street 2:
Practice Address - City:VINCENT
Practice Address - State:OH
Practice Address - Zip Code:45784-5514
Practice Address - Country:US
Practice Address - Phone:740-760-8593
Practice Address - Fax:740-760-8594
Is Sole Proprietor?:No
Enumeration Date:2015-04-30
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVCP022191T225100000X
OHPT018618225100000X
261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist