Provider Demographics
NPI:1104095843
Name:GETER, MELISSA HOPE (PTA)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:HOPE
Last Name:GETER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 OLDE TRACE RD
Mailing Address - Street 2:
Mailing Address - City:VICKSBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39180-7156
Mailing Address - Country:US
Mailing Address - Phone:601-831-7764
Mailing Address - Fax:
Practice Address - Street 1:108 OLDE TRACE RD
Practice Address - Street 2:
Practice Address - City:VICKSBURG
Practice Address - State:MS
Practice Address - Zip Code:39180-7156
Practice Address - Country:US
Practice Address - Phone:601-831-7764
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-27
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4267174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist