Provider Demographics
NPI:1720232093
Name:RATHBONE, MELISSA LYNN (LAC, LMT)
Entity Type:Individual
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First Name:MELISSA
Middle Name:LYNN
Last Name:RATHBONE
Suffix:
Gender:F
Credentials:LAC, LMT
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:928 BROADWAY
Mailing Address - Street 2:SUITE 904
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-6008
Mailing Address - Country:US
Mailing Address - Phone:646-322-4690
Mailing Address - Fax:212-375-9931
Practice Address - Street 1:928 BROADWAY
Practice Address - Street 2:SUITE 904
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-6008
Practice Address - Country:US
Practice Address - Phone:646-322-4690
Practice Address - Fax:212-375-9931
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-12
Last Update Date:2008-11-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY002565171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist