Basic Information
| Provider Information | |||||||||
| NPI: | 1497900351 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MELNICZUK | ||||||||
| FirstName: | REBECCA | ||||||||
| MiddleName: | L. | ||||||||
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| Credential: | D.P.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 84 E GRANT ST | ||||||||
| Address2: | SUITE #3 | ||||||||
| City: | WOODSTOWN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080981400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8567694564 | ||||||||
| FaxNumber: | 8567694637 | ||||||||
| Practice Location | |||||||||
| Address1: | 84 E GRANT ST | ||||||||
| Address2: | SUITE #3 | ||||||||
| City: | WOODSTOWN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080981400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8567694564 | ||||||||
| FaxNumber: | 8567694637 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/19/2008 | ||||||||
| LastUpdateDate: | 10/05/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT018349 | PA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.