Provider Demographics
NPI:1043269582
Name:MELLOW, LISA A (PT)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:A
Last Name:MELLOW
Suffix:
Gender:F
Credentials:PT
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Mailing Address - Street 1:1524 ATWOOD AVE
Mailing Address - Street 2:DBA/ROBERT BUONANNO
Mailing Address - City:JOHNSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02919-3228
Mailing Address - Country:US
Mailing Address - Phone:401-351-6200
Mailing Address - Fax:401-351-6201
Practice Address - Street 1:1524 ATWOOD AVE
Practice Address - Street 2:DBA/ROBERT BUONANNO
Practice Address - City:JOHNSTON
Practice Address - State:RI
Practice Address - Zip Code:02919-3228
Practice Address - Country:US
Practice Address - Phone:401-351-6200
Practice Address - Fax:401-351-6201
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2009-04-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
RIPT00687225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI7354OtherBCBS
RI204194/409026OtherBLUECHIP
1215115OtherCOVENTRY HEALTH
CD1829OtherRAILROAD MEDICARE
RI050397249OtherUNITEDHEALTHCARE
050397249OtherPEQUOT PLUS HEALTH PLANS
SC0771230001OtherDME REGION C
1043269582OtherTUFTS HEALTH PLANS
12296688OtherMULTIPLAN
050397249OtherFIRST HLTH/COVENTRY/HCVM
050397249OtherWORKERS COMPENSATION
MA0771230001OtherDMEMAC REGION A
RI27673OtherNEIGHBORHOOD HEALTH PLANS
MAAA64883OtherHARVARD HEALTH PLANS
RI7354OtherBCBS