Provider Demographics
NPI:1093085755
Name:MELLO-LIEBERMAN, GAIL ELLEN (PT)
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:ELLEN
Last Name:MELLO-LIEBERMAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:GAIL
Other - Middle Name:ELLEN
Other - Last Name:MAIL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2222 SULLIVAN TRL
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18040-7958
Mailing Address - Country:US
Mailing Address - Phone:800-944-9782
Mailing Address - Fax:610-438-2046
Practice Address - Street 1:4201 SPRINGTREE DR
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33351-6163
Practice Address - Country:US
Practice Address - Phone:954-742-4700
Practice Address - Fax:954-742-4700
Is Sole Proprietor?:No
Enumeration Date:2012-01-11
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT3911225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist