Provider Demographics
NPI:1437586849
Name:MELILLO, ROBIN HEATHER (PTA)
Entity Type:Individual
Prefix:MRS
First Name:ROBIN
Middle Name:HEATHER
Last Name:MELILLO
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:ROBIN
Other - Middle Name:HEATHER
Other - Last Name:SILBERBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4411 EAST ADOBE DRIVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85050
Mailing Address - Country:US
Mailing Address - Phone:732-616-9459
Mailing Address - Fax:
Practice Address - Street 1:5314 NORTH 7TH STREET
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014
Practice Address - Country:US
Practice Address - Phone:602-212-9000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-30
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10093A225200000X
NJ40QB00111700225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant