Provider Demographics
NPI:1104937135
Name:CROSBY, MELISA T (PT)
Entity type:Individual
Prefix:
First Name:MELISA
Middle Name:T
Last Name:CROSBY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505A ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:INTERLACHEN
Mailing Address - State:FL
Mailing Address - Zip Code:32148-5433
Mailing Address - Country:US
Mailing Address - Phone:386-684-9110
Mailing Address - Fax:386-684-9255
Practice Address - Street 1:505A ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:INTERLACHEN
Practice Address - State:FL
Practice Address - Zip Code:32148-5433
Practice Address - Country:US
Practice Address - Phone:386-684-9110
Practice Address - Fax:386-684-9255
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 8102225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY931DOtherBCBS
FL8853835 00Medicaid
FLY8180OtherBLUE CROSS AND BLUE SHIEL
FLY8180AMedicare ID - Type UnspecifiedINDIVIDUAL