Provider Demographics
NPI:1700037140
Name:ANGELILLI, MELISSA ANN (PTA)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANN
Last Name:ANGELILLI
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:ANN
Other - Last Name:WESNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:1953 REVOLUTIONARY CT
Mailing Address - Street 2:
Mailing Address - City:PHOENIXVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19460-4714
Mailing Address - Country:US
Mailing Address - Phone:610-800-8538
Mailing Address - Fax:
Practice Address - Street 1:600 W VALLEY FORGE RD
Practice Address - Street 2:
Practice Address - City:KING OF PRUSSIA
Practice Address - State:PA
Practice Address - Zip Code:19406-1571
Practice Address - Country:US
Practice Address - Phone:610-337-1775
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-03
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE005006225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant