Provider Demographics
NPI:1073670071
Name:AILOR, MELISSA ANNE (PT)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANNE
Last Name:AILOR
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2311 BROOKE CIR
Mailing Address - Street 2:
Mailing Address - City:WATERVLIET
Mailing Address - State:NY
Mailing Address - Zip Code:12189-3143
Mailing Address - Country:US
Mailing Address - Phone:518-892-9907
Mailing Address - Fax:
Practice Address - Street 1:711 TROY SCHENECTADY RD
Practice Address - Street 2:SUITE 214
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-2442
Practice Address - Country:US
Practice Address - Phone:518-690-2882
Practice Address - Fax:518-690-2884
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.012858225100000X
MO2001028979225100000X
NY029689-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP00467110OtherRAILROAD MEDICARE
NYRB6185Medicare PIN