| Doctor Name: | RYAN JAKE MELLOTT |
| NPI Number: | 1245220011 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PT |
| License Number: | 6891 |
| Business Practice Address: | 95 1st Ave Monte Vista, CO - 811441069 |
| Business Phone Number: | 7198522512 |
| Business Fax Number: | 7198523923 |
| Mailing Address: | 95 1st Ave, MONTE VISTA |
| State: | CO |
| Postal Code: | 811441070 |
| Phone Number: | 7198522512 |
| Fax Number: | 7198523923 |
| NPI Enumeration Date: | 10/24/2005 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | 6891 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CO |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |