Provider Demographics
NPI:1790052066
Name:MASSARO, MELISSA A (PT)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:A
Last Name:MASSARO
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 1:231 WALTON STREET
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13202-1230
Mailing Address - Country:US
Mailing Address - Phone:315-478-0380
Mailing Address - Fax:315-478-0388
Practice Address - Street 1:4886 WEST TAFT ROAD
Practice Address - Street 2:
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13088-4889
Practice Address - Country:US
Practice Address - Phone:315-457-5867
Practice Address - Fax:315-457-6306
Is Sole Proprietor?:No
Enumeration Date:2011-11-30
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033883225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist