Provider Demographics
NPI:1710947429
Name:ESPIRITU, MELODY A (PT)
Entity Type:Individual
Prefix:MRS
First Name:MELODY
Middle Name:A
Last Name:ESPIRITU
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MELODY
Other - Middle Name:D
Other - Last Name:ALEONAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16 WOODLEIGH CT
Mailing Address - Street 2:
Mailing Address - City:HOLBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11741-2821
Mailing Address - Country:US
Mailing Address - Phone:631-207-3632
Mailing Address - Fax:
Practice Address - Street 1:2805 VETERANS MEMORIAL HWY STE 8
Practice Address - Street 2:
Practice Address - City: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
Is Sole Proprietor?:No
Enumeration Date:2006-03-25
Last Update Date:2022-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016946-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist