Provider Demographics
NPI:1679290217
Name:MELISSA J LONG
Entity Type:Organization
Organization Name:MELISSA J LONG
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:JOAN
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:609-923-6875
Mailing Address - Street 1:128 W HEATHER RD
Mailing Address - Street 2:
Mailing Address - City:WILDWOOD CREST
Mailing Address - State:NJ
Mailing Address - Zip Code:08260-1326
Mailing Address - Country:US
Mailing Address - Phone:609-923-6875
Mailing Address - Fax:
Practice Address - Street 1:128 W HEATHER RD
Practice Address - Street 2:
Practice Address - City:WILDWOOD CREST
Practice Address - State:NJ
Practice Address - Zip Code:08260-1326
Practice Address - Country:US
Practice Address - Phone:609-923-6875
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-25
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty