Provider Demographics
NPI:1336376219
Name:LONG, MELISSA DIANE (EDD, ATC, LAT, PES)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:DIANE
Last Name:LONG
Suffix:
Gender:F
Credentials:EDD, ATC, LAT, PES
Other - Prefix:MS
Other - First Name:MELISSA
Other - Middle Name:DIANE
Other - Last Name:SCHAU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:713 EDWARD CT
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79601-2065
Mailing Address - Country:US
Mailing Address - Phone:817-807-6539
Mailing Address - Fax:
Practice Address - Street 1:1600 CAMPUS CT
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79699-1201
Practice Address - Country:US
Practice Address - Phone:817-807-6539
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-17
Last Update Date:2019-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT121885225700000X
2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist