Basic Information
| Provider Information | |||||||||
| NPI: | 1174736417 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PRICE | ||||||||
| FirstName: | MELISSA | ||||||||
| MiddleName: | JEAN | ||||||||
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| Credential: | PHYSICAL THERAPIST | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | JAMES | ||||||||
| OtherFirstName: | MELISSA | ||||||||
| OtherMiddleName: | JEAN | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 3061 STATE ROUTE 28 | ||||||||
| Address2: | |||||||||
| City: | HERKIMER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 133501041 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3157170020 | ||||||||
| FaxNumber: | 3157170024 | ||||||||
| Practice Location | |||||||||
| Address1: | 3061 STATE ROUTE 28 | ||||||||
| Address2: | |||||||||
| City: | HERKIMER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 133501041 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3157170020 | ||||||||
| FaxNumber: | 3157170024 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/07/2007 | ||||||||
| LastUpdateDate: | 03/16/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/16/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2251X0800X | 029585-1 | NY | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Orthopedic | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 225100000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.