Provider Demographics
NPI:1225803315
Name:MEJIA-PICARD, MELANIE MARTINA
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:MARTINA
Last Name:MEJIA-PICARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6840 COOLIDGE HWY
Mailing Address - Street 2:
Mailing Address - City:GUILFORD
Mailing Address - State:VT
Mailing Address - Zip Code:05301-8641
Mailing Address - Country:US
Mailing Address - Phone:646-942-0134
Mailing Address - Fax:
Practice Address - Street 1:6840 COOLIDGE HWY
Practice Address - Street 2:
Practice Address - City:GUILFORD
Practice Address - State:VT
Practice Address - Zip Code:05301-8641
Practice Address - Country:US
Practice Address - Phone:646-942-0134
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-17
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT041.0092478225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant