Individual
JUSTIN DEREK MELLOTT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
23 FITNESS LN, BERKELEY SPRINGS, WV 25411-7080
(304) 258-1300
Mailing address
13808 JENNY LN NE, LITTLE ORLEANS, MD 21766-1034
(301) 697-4004
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PT002131
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PT002131
PHYSICAL THERAPY
WV
Enumeration date
12/06/2021
Last updated
12/06/2021
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