Melissa Fanning Tate, PT
Individual provider Active NPI Physical Therapist · Albany, LA
NPI 1740560481 · NPPES record last updated Jan 18, 2022
Key facts
- NPI
- 1740560481
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 06400 (LA)
- Practice address
- 19089 Florida Blvd
Albany, LA 70711-3603 - Phone
- (225) 209-7140
- NPI assigned
- Aug 25, 2011
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Physical Therapist in Private Practice
- Education
- Other, 2003
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- 360 Therapy LLC
Practice addresses (Care Compare)
54033 Hwy 1062
Suite B
Loranger, LA 70446-3538
Phone (985) 606-5036
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in LA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160616001998 | LA | Practitioner - Physical Therapist in Private Practice | 8921398223 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 06400 | LA | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Family Healthcare of Loranger, LLC | Current |
Accepting new patients | |
| 360 Therapy, LLC | Physical Therapist | Current |
Accepting new patients |
Locations
29644 S Montpelier Rd
#A
Albany, LA 70711
19089 Florida Blvd
Albany, LA 70711
Phone (225) 209-7140
706 Avenue G
Ste 2
Kentwood, LA 70444
Phone (985) 614-5000
54033 Highway 1062
#B
Loranger, LA 70446
Phone (225) 209-7140
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Physical Therapist | 2251P0200X | 06400 | LA | |
| Physical Therapist | 225100000X | 06400 | LA | Yes |
Addresses
Primary practice location
19089 Florida Blvd
Albany, LA 70711-3603
Mailing address
PO Box 1536
Albany, LA 70711-1536
Phone (985) 320-0264
Other practice location 1
54033 Highway 1062 Ste B
Loranger, LA 70446-3538
Phone (225) 209-7140
Other providers in Albany, LA
- Bobbi Gwen Smith
- John Henry Smith
- Sarah Elaine Spano
- Emily Spurgeon
- St Michael Hospice, LLC
- Kimberly Thai
- Sharmon P Thompson
- Shelbi Vickers
- Richard Wale
- Ashley Durbin Wells
All providers in Albany, LA · Physical Therapist in Louisiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 18, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.