Provider Demographics
NPI:1902057201
Name:DURANTE, MELISSA JANE (PTA)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:JANE
Last Name:DURANTE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1611 SAVANNAH HWY
Mailing Address - Street 2:SUITE C
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-2254
Mailing Address - Country:US
Mailing Address - Phone:843-556-1745
Mailing Address - Fax:843-556-3833
Practice Address - Street 1:1611 SAVANNAH HWY
Practice Address - Street 2:SUITE C
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-2254
Practice Address - Country:US
Practice Address - Phone:843-556-1745
Practice Address - Fax:843-556-3833
Is Sole Proprietor?:No
Enumeration Date:2008-10-06
Last Update Date:2008-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2140225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant