Provider Demographics
NPI:1447726963
Name:WIEAND, MELISSA ADDIE (ATC)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:ADDIE
Last Name:WIEAND
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 COLONIAL WAY
Mailing Address - Street 2:
Mailing Address - City:INDIAN HARBOUR BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32937-4305
Mailing Address - Country:US
Mailing Address - Phone:321-266-2115
Mailing Address - Fax:
Practice Address - Street 1:9 COLONIAL WAY
Practice Address - Street 2:
Practice Address - City:INDIAN HARBOUR BEACH
Practice Address - State:FL
Practice Address - Zip Code:32937-4305
Practice Address - Country:US
Practice Address - Phone:321-266-2115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-23
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3097-392255A2300X
FLAL60472255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer