Provider Demographics
NPI:1730515784
Name:GALLATIN, MELISSA CONVERSE (PT, OCS, ATC)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:CONVERSE
Last Name:GALLATIN
Suffix:
Gender:F
Credentials:PT, OCS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5971 CANYON CREEK DR
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-7419
Mailing Address - Country:US
Mailing Address - Phone:614-499-7100
Mailing Address - Fax:
Practice Address - Street 1:6515 PULLMAN DR STE 2100
Practice Address - Street 2:
Practice Address - City:LEWIS CENTER
Practice Address - State:OH
Practice Address - Zip Code:43035-7381
Practice Address - Country:US
Practice Address - Phone:614-293-1008
Practice Address - Fax:614-293-6672
Is Sole Proprietor?:No
Enumeration Date:2013-09-23
Last Update Date:2013-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT009715225100000X
OHAT0024552255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer