MEDICARE: MELISSA CROMACK

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	225200000X	Physical Therapy Assistant	PTA00597	RI

General Provider Information

NPI Number	:	1851022008
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA CROMACK

Provider Business Mailing Address
First Line	:	730 KINGSTOWN RD
Second Line	:
City	:	SOUTH KINGSTOWN
State	:	RI
Zip	:	02879-3011
Country	:	US
Telephone Number	:	401-284-3424
Fax Number	:

Provider Business Practice Location Address
First Line	:	730 KINGSTOWN RD
Second Line	:
City	:	SOUTH KINGSTOWN
State	:	RI
Zip	:	02879-3011
Country	:	US
Telephone Number	:	401-284-3424
Fax Number	:

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

Provider Enumeration Date	:	06/20/2022
Last Update Date	:	06/20/2022

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Directions to “ MELISSA CROMACK ” Practice Location

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