Provider Demographics
NPI:1275084105
Name:KRONEISS, MELISSA ANN (LMT)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANN
Last Name:KRONEISS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1540 ELLICOTT CREEK RD
Mailing Address - Street 2:
Mailing Address - City:TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14150-2935
Mailing Address - Country:US
Mailing Address - Phone:716-344-5559
Mailing Address - Fax:
Practice Address - Street 1:1540 ELLICOTT CREEK RD
Practice Address - Street 2:
Practice Address - City:TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14150-2935
Practice Address - Country:US
Practice Address - Phone:716-344-5559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-15
Last Update Date:2016-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020986225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist