Provider Demographics
NPI:1093815060
Name:DORRANCE, MELANIE (PT)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:DORRANCE
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 1:180 WASHINGTON AVENUE EXT
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12203-5347
Mailing Address - Country:US
Mailing Address - Phone:518-456-7831
Mailing Address - Fax:518-456-1563
Practice Address - Street 1:180 WASHINGTON AVENUE EXT
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12203-5347
Practice Address - Country:US
Practice Address - Phone:518-456-7831
Practice Address - Fax:518-456-1563
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0100561225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00310361Medicaid
NY10091465OtherCDPHP
NY000406315001OtherBS OF NENY
NY00310361Medicaid