Provider Demographics
NPI:1073636346
Name:GILDEIN, MELISSA JANE (MPT)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:JANE
Last Name:GILDEIN
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:JANE
Other - Last Name:MANSPEAKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:38 OAKTON DR
Mailing Address - Street 2:
Mailing Address - City:MANTUA
Mailing Address - State:NJ
Mailing Address - Zip Code:08051-2109
Mailing Address - Country:US
Mailing Address - Phone:856-464-9181
Mailing Address - Fax:
Practice Address - Street 1:1237 W SHERMAN AVE
Practice Address - Street 2:
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-6920
Practice Address - Country:US
Practice Address - Phone:856-697-7342
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01150100225100000X
PAPT015052225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist