Provider Demographics
NPI:1225571904
Name:MASSI, AMELIA R
Entity Type:Individual
Prefix:MRS
First Name:AMELIA
Middle Name:R
Last Name:MASSI
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:AMELIA
Other - Middle Name:R
Other - Last Name:MONTANARO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:249 GLENWOOD RD
Mailing Address - Street 2:
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13905-1603
Mailing Address - Country:US
Mailing Address - Phone:607-240-4835
Mailing Address - Fax:
Practice Address - Street 1:1257 TRUMANSBURG RD
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-1313
Practice Address - Country:US
Practice Address - Phone:607-273-0811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-29
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008127-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist