Provider Demographics
NPI:1417788829
Name:RAWLINGS, MELISSA (PTA)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:RAWLINGS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3639 S GREEN FARM WAY
Mailing Address - Street 2:
Mailing Address - City:WEST HAVEN
Mailing Address - State:UT
Mailing Address - Zip Code:84401-1258
Mailing Address - Country:US
Mailing Address - Phone:801-866-9479
Mailing Address - Fax:
Practice Address - Street 1:3639 S GREEN FARM WAY
Practice Address - Street 2:
Practice Address - City:WEST HAVEN
Practice Address - State:UT
Practice Address - Zip Code:84401-1258
Practice Address - Country:US
Practice Address - Phone:801-866-9479
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-08
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9034867-2402225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant