Provider Demographics
NPI:1598417487
Name:MELODY A ESPIRITU PHYSICAL THERAPIST PC
Entity Type:Organization
Organization Name:MELODY A ESPIRITU PHYSICAL THERAPIST PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELODY
Authorized Official - Middle Name:A
Authorized Official - Last Name:ESPIRITU
Authorized Official - Suffix:
Authorized Official - Credentials:PHYSICAL THERAPIST
Authorized Official - Phone:631-676-6324
Mailing Address - Street 1:PO BOX 111
Mailing Address - Street 2:
Mailing Address - City:LAKE GROVE
Mailing Address - State:NY
Mailing Address - Zip Code:11755-0111
Mailing Address - Country:US
Mailing Address - Phone:631-676-6324
Mailing Address - Fax:631-676-6327
Practice Address - Street 1:2805 VETERANS MEMORIAL HWY STE 8
Practice Address - Street 2:
Practice Address - City:LAKE RONKONKOMA
Practice Address - State:NY
Practice Address - Zip Code:11779-7680
Practice Address - Country:US
Practice Address - Phone:631-676-6324
Practice Address - Fax:631-676-6327
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-21
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty