Provider Demographics
NPI:1922317551
Name:BAMFORD, MELISSA ANN (DPT)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:ANN
Last Name:BAMFORD
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MISS
Other - First Name:MELISSA
Other - Middle Name:ANN
Other - Last Name:AMSPACHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:61 CROWN ST
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-3833
Mailing Address - Country:US
Mailing Address - Phone:845-853-4074
Mailing Address - Fax:
Practice Address - Street 1:61 CROWN ST
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-3833
Practice Address - Country:US
Practice Address - Phone:845-853-4074
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-30
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020577-12251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics