Provider Demographics
NPI:1780924886
Name:MCCORMICK, MELANIE (PT)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:MCCORMICK
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 1:865 PUBLISHERS PKWY
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:NY
Mailing Address - Zip Code:14580-2579
Mailing Address - Country:US
Mailing Address - Phone:585-671-3770
Mailing Address - Fax:
Practice Address - Street 1:865 PUBLISHERS PKWY
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:NY
Practice Address - Zip Code:14580-2579
Practice Address - Country:US
Practice Address - Phone:585-671-3770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-26
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY036109174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist