Provider Demographics
NPI:1306610365
Name:ROMINE, MELISA LEE (LMT)
Entity type:Individual
Prefix:
First Name:MELISA
Middle Name:LEE
Last Name:ROMINE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:MELISA
Other - Middle Name:LEE
Other - Last Name:DRAKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:10400 LANCASTER NEWARK RD NE
Mailing Address - Street 2:
Mailing Address - City:MILLERSPORT
Mailing Address - State:OH
Mailing Address - Zip Code:43046-8003
Mailing Address - Country:US
Mailing Address - Phone:740-467-2486
Mailing Address - Fax:
Practice Address - Street 1:10400 LANCASTER NEWARK RD NE
Practice Address - Street 2:
Practice Address - City:MILLERSPORT
Practice Address - State:OH
Practice Address - Zip Code:43046-8003
Practice Address - Country:US
Practice Address - Phone:740-467-2486
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-09
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.021450225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist