Provider Demographics
NPI:1639420854
Name:SEYMOUR, MELISSA SARAH (MSPT)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:SARAH
Last Name:SEYMOUR
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:SARAH
Other - Last Name:BILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSPT
Mailing Address - Street 1:425 WILCOX ST
Mailing Address - Street 2:847
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28203-4144
Mailing Address - Country:US
Mailing Address - Phone:617-852-9909
Mailing Address - Fax:
Practice Address - Street 1:425 WILCOX ST
Practice Address - Street 2:847
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-4144
Practice Address - Country:US
Practice Address - Phone:617-852-9909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-27
Last Update Date:2013-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT27370225100000X
NCP10938225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist