Provider Demographics
NPI:1104837715
Name:WILLIAMS, MELISSA J (MSPT)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:J
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 S JAMES ST
Mailing Address - Street 2:BOUTON PHYSICAL THERAPY
Mailing Address - City:ROME
Mailing Address - State:NY
Mailing Address - Zip Code:13440
Mailing Address - Country:US
Mailing Address - Phone:315-337-1436
Mailing Address - Fax:315-337-1437
Practice Address - Street 1:221 S JAMES ST
Practice Address - Street 2:BOUTON PHYSICAL THERAPY
Practice Address - City:ROME
Practice Address - State:NY
Practice Address - Zip Code:13440
Practice Address - Country:US
Practice Address - Phone:315-337-1436
Practice Address - Fax:315-337-1437
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0275031225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
10101063OtherCDPHP
PO10027503OtherEXCELLUS
NY02692693Medicaid
051213000065OtherFIDELIS
385413OtherMVP
6696836OtherGHI
7343747OtherAETNA
385413OtherMVP