Provider Demographics
NPI:1679805386
Name:DIETZ, MELISSA ANNE (MSPT)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANNE
Last Name:DIETZ
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:ANNE
Other - Last Name:DIETZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSPT
Mailing Address - Street 1:4880 GLENN PINE LN
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33436-6156
Mailing Address - Country:US
Mailing Address - Phone:561-693-8774
Mailing Address - Fax:
Practice Address - Street 1:4880 GLENN PINE LN
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33436-6156
Practice Address - Country:US
Practice Address - Phone:561-693-8774
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-04
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 21895225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist