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Individual
RYAN JAKE MELLOTT
Active
Individual
RYAN JAKE MELLOTT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
6891
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
84070694565
ROCKY MOUNTAIN HEALTH PAN
CO
01
—
ME654882
ANTHEM BCBS
CO
Enumeration date
10/24/2005
Last updated
07/13/2026
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