Justin Derek Mellott

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

PT002131 Issued in WV

Practice address

23 Fitness LN
Berkeley Springs, WV 25411-7080

Phone

(304) 258-1300

NPI assigned

Dec 6, 2021

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1638748800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638748800000",
    "number": "1972261139",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13808 JENNY LN NE",
            "city": "LITTLE ORLEANS",
            "state": "MD",
            "postal_code": "217661034",
            "telephone_number": "301-697-4004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23 FITNESS LN",
            "city": "BERKELEY SPRINGS",
            "state": "WV",
            "postal_code": "254117080",
            "telephone_number": "304-258-1300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MELLOTT",
        "first_name": "JUSTIN",
        "middle_name": "DEREK",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-12-06",
        "last_updated": "2021-12-06",
        "certification_date": "2021-12-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "WV",
            "license": "PT002131",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHYSICAL THERAPY",
            "identifier": "PT002131",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kim Allison McCoy
• James J McFarland
• Kevin Thomas McLaughlin, DO
• Bethany Mechem
• Jazmin N Mellott
• Suzanne B Mellott, CCC-SLP
• Michael Family Practice PLLC
• Amanda Gail Michael, D.O.
• Ashley Elizabeth Miller
• Christopher Miller

• Physical Therapy Assistant in Berkeley Springs, WV
• Providers in Berkeley Springs, WV by specialty
• Physical Therapy Assistant in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.