Provider Demographics
NPI:1669887014
Name:TODD-JOHNSON, MELISSA IRENE (MPT)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:IRENE
Last Name:TODD-JOHNSON
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 RIVA RD STE 130
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-7437
Mailing Address - Country:US
Mailing Address - Phone:410-266-8010
Mailing Address - Fax:443-782-2498
Practice Address - Street 1:2525 RIVA RD STE 130
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-7437
Practice Address - Country:US
Practice Address - Phone:410-266-8010
Practice Address - Fax:443-782-2498
Is Sole Proprietor?:No
Enumeration Date:2014-06-24
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD19365225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist