Provider Demographics
NPI:1548709702
Name:MUNN, MELISSA ANN (PT)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANN
Last Name:MUNN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 SANFORD AVE
Mailing Address - Street 2:
Mailing Address - City:EUFAULA
Mailing Address - State:AL
Mailing Address - Zip Code:36027-1423
Mailing Address - Country:US
Mailing Address - Phone:334-695-2474
Mailing Address - Fax:
Practice Address - Street 1:705 17TH ST STE 407
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31901-3514
Practice Address - Country:US
Practice Address - Phone:706-321-0930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-20
Last Update Date:2020-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH8334225100000X
CA298190225100000X
VA2305212895225100000X
MA000024311225100000X
GAPT012797225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist