Provider Demographics
NPI:1780892463
Name:LIBOW, MELISSA TIFFORD (MPT)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:TIFFORD
Last Name:LIBOW
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 1:731 PARKSIDE CIR N
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-5236
Mailing Address - Country:US
Mailing Address - Phone:561-306-1968
Mailing Address - Fax:561-367-6172
Practice Address - Street 1:2275 S FEDERAL HWY
Practice Address - Street 2:SUITE#280
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33483-3337
Practice Address - Country:US
Practice Address - Phone:561-278-2200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 14603225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLYO92JZMedicare ID - Type UnspecifiedPHYSICAL THERAPIST