Provider Demographics
NPI:1356644777
Name:ROSABELLA, MELANIE ISABELLE (LMT)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:ISABELLE
Last Name:ROSABELLA
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:MELANIE
Other - Middle Name:ISABELLE
Other - Last Name:MODJESKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:28750 TRAILS EDGE BLVD UNIT 404
Mailing Address - Street 2:
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34134-7534
Mailing Address - Country:US
Mailing Address - Phone:845-514-3892
Mailing Address - Fax:239-236-0647
Practice Address - Street 1:24850 OLD HIGHWAY 41 ROAD
Practice Address - Street 2:SUITE 17
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34135
Practice Address - Country:US
Practice Address - Phone:239-947-3900
Practice Address - Fax:239-236-0647
Is Sole Proprietor?:No
Enumeration Date:2010-12-07
Last Update Date:2011-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7242372225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist