Provider Demographics
NPI:1497900351
Name:MELNICZUK, REBECCA L (DPT)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:L
Last Name:MELNICZUK
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:84 E GRANT ST
Mailing Address - Street 2:SUITE #3
Mailing Address - City:WOODSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08098-1400
Mailing Address - Country:US
Mailing Address - Phone:856-769-4564
Mailing Address - Fax:856-769-4637
Practice Address - Street 1:84 E GRANT ST
Practice Address - Street 2:SUITE #3
Practice Address - City:WOODSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08098-1400
Practice Address - Country:US
Practice Address - Phone:856-769-4564
Practice Address - Fax:856-769-4637
Is Sole Proprietor?:No
Enumeration Date:2008-11-19
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT018349225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist