Provider Demographics
NPI:1417767989
Name:PULOS, MELINA
Entity type:Individual
Prefix:
First Name:MELINA
Middle Name:
Last Name:PULOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16907 1ST AVE E
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34212-5606
Mailing Address - Country:US
Mailing Address - Phone:262-443-9325
Mailing Address - Fax:
Practice Address - Street 1:5860 RANCH LAKE BLVD STE 102
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34202-3719
Practice Address - Country:US
Practice Address - Phone:941-417-8300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-08
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTT42683225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist