Provider Demographics
NPI:1245891407
Name:LEASER, MELISSA ANN (DPT)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANN
Last Name:LEASER
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 1:99 DEAD END LN
Mailing Address - Street 2:
Mailing Address - City:LEHIGHTON
Mailing Address - State:PA
Mailing Address - Zip Code:18235-9566
Mailing Address - Country:US
Mailing Address - Phone:570-386-9991
Mailing Address - Fax:
Practice Address - Street 1:100 W PATTERSON ST
Practice Address - Street 2:
Practice Address - City:LANSFORD
Practice Address - State:PA
Practice Address - Zip Code:18232-1304
Practice Address - Country:US
Practice Address - Phone:570-645-8197
Practice Address - Fax:570-645-1429
Is Sole Proprietor?:No
Enumeration Date:2019-06-27
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT016400225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist