Melisa T Crosby, PT P.a.

Key facts

NPI

1104937150

Entity type

Organization (NPI type 2)

Primary specialty

Physical Therapist 225100000X

License

PT 8102 (FL)

Legal business name

MELISA T CROSBY, PT P.A.

Practice address

885 State Road 20
Interlachen, FL 32148-2430

Phone

(386) 684-9110

Fax

(386) 684-9255

NPI assigned

Aug 31, 2006

Organization subpart

No

Authorized official

Name

Amie Carle

Title

Administrative Director

Phone

(386) 684-9110

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Melisa T Crosby, PT P.a. Physical Therapy Clinic/Center · East Palatka, FL · NPI 1306419270
  Same enrollment O20070510000455

Corporate family (same tax ID) 1

Organizations that report the same tax identification number in the National Provider Directory.

• Melisa T Crosby, PT P.a. Physical Therapy Clinic/Center · East Palatka, FL · NPI 1306419270
  NPD tax ID

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Melisa T Crosby, PT Physical Therapist · Interlachen, FL · NPI 1104937135
  Medicare reassignment Care Compare group NPD FL · PHYSICAL THERAPIST
• Lynne Alicia Ryden, P.T. Physical Therapist · La Mesa, CA · NPI 1396751517
  Medicare reassignment Care Compare group NPD FL · PHYSICAL THERAPIST
• Jason David Anderson, OTR/L Occupational Therapist · Interlachen, FL · NPI 1902981483
  NPD (past)

Medicare participation

Medicare fee-for-service enrollment

Enrolled in FL

Medicare enrollment records

National Provider Directory

Tax ID family

Fyzical Therapy Balance Centers (2 organizations share this tax ID)

Locations

Specialties & licenses

Addresses

Other identifiers

Other names

• FYZICAL Therapy & Balance Centers Doing business as

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jul 1, 2022.

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1656633600000",
    "number": "1104937150",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "885 STATE ROAD 20",
            "city": "INTERLACHEN",
            "state": "FL",
            "postal_code": "321482430",
            "telephone_number": "386-684-9110",
            "fax_number": "386-684-9255"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "885 STATE ROAD 20",
            "city": "INTERLACHEN",
            "state": "FL",
            "postal_code": "321482430",
            "telephone_number": "386-684-9110",
            "fax_number": "386-684-9255"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MELISA T CROSBY, PT P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-31",
        "last_updated": "2022-07-01",
        "certification_date": "2022-07-01",
        "status": "A",
        "authorized_official_last_name": "CARLE",
        "authorized_official_first_name": "AMIE",
        "authorized_official_title_or_position": "ADMINISTRATIVE DIRECTOR",
        "authorized_official_telephone_number": "386-684-9110"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "FL",
            "license": "PT 8102",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "891806600",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "FYZICAL Therapy & Balance Centers",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• John T Phipps, LCSW
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All providers in Interlachen, FL · Physical Therapist in Florida