Provider Demographics
NPI:1841747698
Name:GONYAW, MELISSA (PT)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:
Last Name:GONYAW
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 1:2445 EVANSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:BROWNINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05860-9786
Mailing Address - Country:US
Mailing Address - Phone:802-754-8749
Mailing Address - Fax:
Practice Address - Street 1:81 MEDICAL VILLAGE DR
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:VT
Practice Address - Zip Code:05855-9897
Practice Address - Country:US
Practice Address - Phone:802-334-3260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-08
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT040.0003737225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist