Provider Demographics
NPI:1770532202
Name:MCCORMACK, MELISSA ANNE (PT)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:ANNE
Last Name:MCCORMACK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:58 LARKWOOD CT
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22554-1587
Mailing Address - Country:US
Mailing Address - Phone:540-657-2925
Mailing Address - Fax:540-657-7134
Practice Address - Street 1:90 GREENSPRING DR
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554-1752
Practice Address - Country:US
Practice Address - Phone:540-657-2925
Practice Address - Fax:540-657-7134
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA2305006502225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist