Provider Demographics
NPI:1881995157
Name:MULLER, MELANIE A (PTA)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:A
Last Name:MULLER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:MELANIE
Other - Middle Name:A
Other - Last Name:BURNS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CLT
Mailing Address - Street 1:305 CLYDE MORRIS BLVD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-8181
Mailing Address - Country:US
Mailing Address - Phone:386-676-3130
Mailing Address - Fax:
Practice Address - Street 1:305 MEMORIAL MEDICAL PKWY STE 100
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32117-5169
Practice Address - Country:US
Practice Address - Phone:386-231-6038
Practice Address - Fax:386-673-2930
Is Sole Proprietor?:No
Enumeration Date:2010-11-03
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA22302225200000X
FLMA 47555225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist