Provider Demographics
NPI:1174736417
Name:PRICE, MELISSA JEAN (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:JEAN
Last Name:PRICE
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:JEAN
Other - Last Name:JAMES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3061 STATE ROUTE 28
Mailing Address - Street 2:
Mailing Address - City:HERKIMER
Mailing Address - State:NY
Mailing Address - Zip Code:13350-1041
Mailing Address - Country:US
Mailing Address - Phone:315-717-0020
Mailing Address - Fax:315-717-0024
Practice Address - Street 1:3061 STATE ROUTE 28
Practice Address - Street 2:
Practice Address - City:HERKIMER
Practice Address - State:NY
Practice Address - Zip Code:13350-1041
Practice Address - Country:US
Practice Address - Phone:315-717-0020
Practice Address - Fax:315-717-0024
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029585-12251X0800X
390200000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program