Basic Information
Provider Information
NPI: 1720563273
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PAPA
FirstName: MELISSA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: PT
OtherOrganizationName:  
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Mailing Information
Address1: 3809 W CHESTER PIKE STE 150
Address2:  
City: NEWTOWN SQUARE
State: PA
PostalCode: 190730259
CountryCode: US
TelephoneNumber: 6103595671
FaxNumber: 6103591519
Practice Location
Address1: 491 JOHN YOUNG WAY STE 210
Address2:  
City: EXTON
State: PA
PostalCode: 193412567
CountryCode: US
TelephoneNumber: 6105247251
FaxNumber: 6102801506
Other Information
ProviderEnumerationDate: 10/01/2018
LastUpdateDate: 12/10/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
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IsSoleProprietor: N
IsOrganizationSubpart:  
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AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 12/10/2019

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000XPT026911PAY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

No ID Information.


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