Provider Demographics
NPI:1881607190
Name:GILBERT, MELISSA (ATC, LAT)
Entity type:Individual
Prefix:MISS
First Name:MELISSA
Middle Name:
Last Name:GILBERT
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18531 BURGUNDY SKY WAY
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77429-4260
Mailing Address - Country:US
Mailing Address - Phone:281-256-0801
Mailing Address - Fax:
Practice Address - Street 1:22602 NORTHWEST FREEWAY
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77429
Practice Address - Country:US
Practice Address - Phone:281-897-4671
Practice Address - Fax:281-517-2078
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT25982255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer