Provider Demographics
NPI:1144719022
Name:EDWARDS, MELISSA FAYE (PT,DPT)
Entity type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:FAYE
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:PT,DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4537 CAPE SABLE CT
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32277-1062
Mailing Address - Country:US
Mailing Address - Phone:904-612-3686
Mailing Address - Fax:
Practice Address - Street 1:30 SPRINGCREST CT
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-4034
Practice Address - Country:US
Practice Address - Phone:864-372-6971
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-06
Last Update Date:2018-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8822225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist