Provider Demographics
NPI:1144527318
Name:ROOT, MELISSA G (DPT)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:G
Last Name:ROOT
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:MAITLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7255 W SUNSET RD
Mailing Address - Street 2:APT 2039
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-1902
Mailing Address - Country:US
Mailing Address - Phone:203-216-1026
Mailing Address - Fax:
Practice Address - Street 1:321 N BUFFALO DR
Practice Address - Street 2:SUITE 110
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89145-0308
Practice Address - Country:US
Practice Address - Phone:702-341-0606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-23
Last Update Date:2018-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1199418225100000X
PAPT021842225100000X
NV2527225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist