Provider Demographics
NPI:1750303236
Name:CENCETTI, MELISSA A (MSPT)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:A
Last Name:CENCETTI
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 PARNELL ST
Mailing Address - Street 2:
Mailing Address - City:PITTSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18640-3342
Mailing Address - Country:US
Mailing Address - Phone:570-883-0512
Mailing Address - Fax:
Practice Address - Street 1:71 N FRANKLIN ST
Practice Address - Street 2:WYOMING VALLEY CHILDRENS ASSOCAIATION
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18701-1312
Practice Address - Country:US
Practice Address - Phone:570-829-2453
Practice Address - Fax:570-829-2462
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT09255L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA372927OtherBLUE SHIELD GROUP #
PA50058746OtherCAPITAL BLUE CROSS
PA1275526725Medicare ID - Type UnspecifiedGROUP NPI #
PA394508Medicare ID - Type UnspecifiedGROUP #