Provider Demographics
NPI:1730118191
Name:MCCOMBS, MELISSA JOYE (PTA, ATC)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:JOYE
Last Name:MCCOMBS
Suffix:
Gender:F
Credentials:PTA, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1959 MAPLE HILL RD
Mailing Address - Street 2:
Mailing Address - City:HINSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:14743-9752
Mailing Address - Country:US
Mailing Address - Phone:716-307-7142
Mailing Address - Fax:
Practice Address - Street 1:4039 RT. 219
Practice Address - Street 2:SUITE 104
Practice Address - City:SALAMANCA
Practice Address - State:NY
Practice Address - Zip Code:14779-9625
Practice Address - Country:US
Practice Address - Phone:716-945-2484
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2017-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010688-1225200000X
VA2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant