Provider Demographics
NPI:1689080335
Name:MENOR, MELANIE B (PT, DPT, CLT-LANA)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:B
Last Name:MENOR
Suffix:
Gender:F
Credentials:PT, DPT, CLT-LANA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3011 21ST ST APT 2D
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11102-2872
Mailing Address - Country:US
Mailing Address - Phone:347-523-0260
Mailing Address - Fax:
Practice Address - Street 1:3011 21ST ST APT 2D
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11102-2872
Practice Address - Country:US
Practice Address - Phone:347-523-0260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-02
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030267174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist