Provider Demographics
NPI:1326625617
Name:LLANES, MELANIE-ANN (PT)
Entity Type:Individual
Prefix:DR
First Name:MELANIE-ANN
Middle Name:
Last Name:LLANES
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 TERHUNE AVE
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07305-4682
Mailing Address - Country:US
Mailing Address - Phone:201-600-9883
Mailing Address - Fax:
Practice Address - Street 1:39 TERHUNE AVE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07305-4682
Practice Address - Country:US
Practice Address - Phone:201-600-9883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-24
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01911200225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist