Provider Demographics
NPI:1073609046
Name:SWART, MELISSA R (PT)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:R
Last Name:SWART
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:R
Other - Last Name:MUMBULO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:6142 STATE HIGHWAY 12
Mailing Address - Street 2:NORTH PLAZA
Mailing Address - City:NORWICH
Mailing Address - State:NY
Mailing Address - Zip Code:13815-3536
Mailing Address - Country:US
Mailing Address - Phone:607-337-4227
Mailing Address - Fax:607-337-4094
Practice Address - Street 1:6142 STATE HIGHWAY 12
Practice Address - Street 2:NORTH PLAZA
Practice Address - City:NORWICH
Practice Address - State:NY
Practice Address - Zip Code:13815-3536
Practice Address - Country:US
Practice Address - Phone:607-337-4227
Practice Address - Fax:607-337-4094
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026909-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist