Provider Demographics
NPI:1245075787
Name:MELLA, MARGARET ANNE (LMT)
Entity type:Individual
Prefix:MS
First Name:MARGARET
Middle Name:ANNE
Last Name:MELLA
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 1:5144 ANGOLA ST
Mailing Address - Street 2:
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-3919
Mailing Address - Country:US
Mailing Address - Phone:407-399-3691
Mailing Address - Fax:
Practice Address - Street 1:5144 ANGOLA ST
Practice Address - Street 2:
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-3919
Practice Address - Country:US
Practice Address - Phone:407-399-3691
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-26
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA43970225700000X
FLCH15106111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist