Provider Demographics
NPI:1821170390
Name:OMMUNDSEN, MELISSA ROBIN (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:ROBIN
Last Name:OMMUNDSEN
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:10 ALDER DR
Mailing Address - Street 2:
Mailing Address - City:KINGS PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11754-2202
Mailing Address - Country:US
Mailing Address - Phone:631-360-3615
Mailing Address - Fax:
Practice Address - Street 1:10 ALDER DR
Practice Address - Street 2:
Practice Address - City:KINGS PARK
Practice Address - State:NY
Practice Address - Zip Code:11754-2202
Practice Address - Country:US
Practice Address - Phone:631-360-3615
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2020-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028671-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist