Provider Demographics
NPI:1699800763
Name:AMMIRATI, MELISSA (DPT)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:AMMIRATI
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:BERCHTOLD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:20 N MICHIGAN AVE
Mailing Address - Street 2:STE 103
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602-4811
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:20 N MICHIGAN AVE
Practice Address - Street 2:STE 103
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-4811
Practice Address - Country:US
Practice Address - Phone:312-236-0660
Practice Address - Fax:312-236-1219
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070015285225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist