Healthcare Provider Details

I. General information

NPI: 1679290217
Provider Name (Legal Business Name): MELISSA J LONG
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2022
Last Update Date: 10/25/2022
Certification Date: 10/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 W HEATHER RD
WILDWOOD CREST NJ
08260-1326
US

IV. Provider business mailing address

128 W HEATHER RD
WILDWOOD CREST NJ
08260-1326
US

V. Phone/Fax

Practice location:
  • Phone: 609-923-6875
  • Fax:
Mailing address:
  • Phone: 609-923-6875
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MELISSA JOAN LONG
Title or Position: PHYSICAL THERAPIST
Credential: PT, DPT
Phone: 609-923-6875