Provider Demographics
NPI:1821664731
Name:OVALLES, MELODY (DPT)
Entity Type:Individual
Prefix:
First Name:MELODY
Middle Name:
Last Name:OVALLES
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 VERMILYEA AVE APT 5E
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10034-4445
Mailing Address - Country:US
Mailing Address - Phone:917-736-7395
Mailing Address - Fax:
Practice Address - Street 1:15 CENTER ST # 1
Practice Address - Street 2:
Practice Address - City:ARDSLEY
Practice Address - State:NY
Practice Address - Zip Code:10502-1805
Practice Address - Country:US
Practice Address - Phone:914-488-5763
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-01
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047204225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist