Basic Information
| Provider Information | |||||||||
| NPI: | 1285672923 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TUTAS | ||||||||
| FirstName: | MELISSA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | MSPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2700 FARM VIEW DR | ||||||||
| Address2: | |||||||||
| City: | FALLSTON | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210471302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4434147139 | ||||||||
| FaxNumber: | 4109415057 | ||||||||
| Practice Location | |||||||||
| Address1: | 3465 BOX HILL CORPORATE CENTER DR | ||||||||
| Address2: | SUITE G | ||||||||
| City: | ABINGDON | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210091261 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4105694806 | ||||||||
| FaxNumber: | 4105695474 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/03/2006 | ||||||||
| LastUpdateDate: | 08/20/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 19053 | MD | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 4842670001 | 01 | MD | DME POS ASSIGNED | OTHER | 522248150 | 01 | MD | COVENTRY HEALTHCARE OF DE | OTHER | 522248150 | 01 | MD | INTEGRATED HAELTH PLAN | OTHER | 0007263155 | 01 | MD | AETNA | OTHER | 2144336 | 01 | MD | OPTIMUM CHOICE | OTHER | 650018560 | 01 | MD | RAILROAD MEDICARE | OTHER | 401764100 | 05 | MD | MEDICAID | 51647 | 01 | MD | EHP, KAISER, PRIORITY PAR | OTHER | 522248150 | 01 | MD | TRICARE STANDARD | OTHER | 522248150 | 01 | MD | CIGNA | OTHER | T121-0001 | 01 | MD | FED BCBS | OTHER | 2144336 | 01 | MD | ALLIANCE | OTHER | 76934702 | 01 | MD | CAREFIRST BCBS RENDERING | OTHER | T121-0001 | 01 | MD | BLUE CHOICE | OTHER | 350342400 | 01 | MD | OWCP | OTHER |