Provider Demographics
NPI:1760499495
Name:RAYMOND, MELANIE J (PT)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:J
Last Name:RAYMOND
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4275 DILDINE RD
Mailing Address - Street 2:
Mailing Address - City:UNION SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:13160
Mailing Address - Country:US
Mailing Address - Phone:315-889-7134
Mailing Address - Fax:
Practice Address - Street 1:2685 ERIE DR
Practice Address - Street 2:RAYMOND PHYSICAL THERAPY PLLC
Practice Address - City:WEEDSPORT
Practice Address - State:NY
Practice Address - Zip Code:13166
Practice Address - Country:US
Practice Address - Phone:315-834-6496
Practice Address - Fax:315-834-6499
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0110531225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01701720Medicaid
S43612Medicare UPIN
NY01701720Medicaid