Provider Demographics
NPI:1194971978
Name:GAUDETTE, MELISSA AILEEN (PT, DPT)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:AILEEN
Last Name:GAUDETTE
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:AILEEN
Other - Last Name:STELMACKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:6480 HARRISON AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45247-7961
Mailing Address - Country:US
Mailing Address - Phone:513-354-7662
Mailing Address - Fax:513-354-7651
Practice Address - Street 1:8020 LIBERTY WAY
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-2519
Practice Address - Country:US
Practice Address - Phone:513-246-2270
Practice Address - Fax:513-860-0713
Is Sole Proprietor?:No
Enumeration Date:2008-08-13
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5803225100000X
GAPT012665225100000X
OHPT020037225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC5803OtherSC LICENSE