Individual
MELISSA FANNING TATE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
19089 FLORIDA BLVD, ALBANY, LA 70711-3603
(225) 209-7140
Mailing address
PO BOX 1536, ALBANY, LA 70711-1536
(985) 320-0264
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
06400
LA
2251P0200X
Pediatric Physical Therapist
06400
LA
Other
Enumeration date
08/25/2011
Last updated
01/18/2022
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