MEDICARE: MELISSA LEBRON PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT018466	PA

General Provider Information

NPI Number	:	1346366416
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA LEBRON PT

Provider Business Mailing Address
First Line	:	133 W HUNTING PARK AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19140-2717
Country	:	US
Telephone Number	:	215-455-5370
Fax Number	:	215-455-5374

Provider Business Practice Location Address
First Line	:	3251 CEDAR ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19134-4514
Country	:	US
Telephone Number	:	215-427-2242
Fax Number	:	215-455-5374

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/21/2007
Last Update Date	:	06/14/2016

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