Provider Demographics
NPI:1538136601
Name:MARVIN-MELZER, MELISSA JILLL (PT)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:JILLL
Last Name:MARVIN-MELZER
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 1:3 RONALD CT
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON
Mailing Address - State:NY
Mailing Address - Zip Code:11777-1156
Mailing Address - Country:US
Mailing Address - Phone:631-331-5039
Mailing Address - Fax:
Practice Address - Street 1:3 RONALD CT
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON
Practice Address - State:NY
Practice Address - Zip Code:11777-1156
Practice Address - Country:US
Practice Address - Phone:631-331-5039
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016725-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist