Provider Demographics
NPI:1578647723
Name:TAYLOR, MELISSA CHRISTINE (MPT)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:CHRISTINE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:CHRISTINE
Other - Last Name:ROEHM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:21669 TELEGRAPH RD
Mailing Address - Street 2:
Mailing Address - City:BROWNSTOWN TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48183-1338
Mailing Address - Country:US
Mailing Address - Phone:734-307-0911
Mailing Address - Fax:
Practice Address - Street 1:21669 TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:BROWNSTOWN TWP
Practice Address - State:MI
Practice Address - Zip Code:48183-1338
Practice Address - Country:US
Practice Address - Phone:734-307-0911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI550102324225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIM93060004Medicare ID - Type UnspecifiedSECOND PROVIDER