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RYAN JAKE MELLOTT PT

>> Physical Therapist >> Respiratory, Developmental, Rehabilitative and Restorative Service Providers

Registrant NPI Number: 1245220011

Individual Registrant:
 RYAN JAKE MELLOTT PT
Gender: M

Location and contact information for practice:
95 1ST AVE  MONTE VISTA, CO 81144-1069 US
Tel: 719-852-2512  Fax: 719-852-3923

Contact information for business:
95 1ST AVE  MONTE VISTA, CO 81144-1070 US
Tel: 719-852-2512  Fax: 719-852-3923

Registration Information:
NPI: 1245220011
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y225100000XRespiratory, Developmental, Rehabilitative and Restorative Service Providers
Physical Therapist
CO6891

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType
ANTHEM BCBSME654882CO01
ROCKY MOUNTAIN HEALTH PAN84070694565CO01




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