Provider Demographics
NPI:1215791892
Name:ALLEN, MELISSA JAYNE (PT, DPT)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:JAYNE
Last Name:ALLEN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:JAYNE
Other - Last Name:BRIDENBAUGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1162 E 6600 S APT 2
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84121-2485
Mailing Address - Country:US
Mailing Address - Phone:908-246-3322
Mailing Address - Fax:
Practice Address - Street 1:4624 S HOLLADAY BLVD STE 2
Practice Address - Street 2:
Practice Address - City:HOLLADAY
Practice Address - State:UT
Practice Address - Zip Code:84117-7169
Practice Address - Country:US
Practice Address - Phone:801-277-1028
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-13
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13459829-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist