Provider Demographics
NPI:1952414088
Name:ALONSO, MELISSA ANN (PT)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANN
Last Name:ALONSO
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 1:124 BERMUDA DR
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:43031-9601
Mailing Address - Country:US
Mailing Address - Phone:614-352-0399
Mailing Address - Fax:
Practice Address - Street 1:32 S MAIN ST
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:OH
Practice Address - Zip Code:43031-1225
Practice Address - Country:US
Practice Address - Phone:740-967-0303
Practice Address - Fax:740-967-2332
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT010319225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist