Provider Demographics
NPI:1851683858
Name:GONZAGA-LEE, MELISSA KUIZON (PT, DPT, CSRS)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:KUIZON
Last Name:GONZAGA-LEE
Suffix:
Gender:F
Credentials:PT, DPT, CSRS
Other - Prefix:MS
Other - First Name:MELISSA
Other - Middle Name:KUIZON
Other - Last Name:GONZAGA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:34 NAKATA AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRHAVEN
Mailing Address - State:MA
Mailing Address - Zip Code:02719-2002
Mailing Address - Country:US
Mailing Address - Phone:505-917-9131
Mailing Address - Fax:
Practice Address - Street 1:2360 CRANBERRY HWY FL 2
Practice Address - Street 2:
Practice Address - City:WEST WAREHAM
Practice Address - State:MA
Practice Address - Zip Code:02576-1208
Practice Address - Country:US
Practice Address - Phone:774-678-4041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-09
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA19680225100000X
PAPT020507225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist