Healthcare Provider Details

I. General information

NPI: 1902044167
Provider Name (Legal Business Name): MELISSA RENE RAY PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2009
Last Update Date: 07/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 SWEET HOME RD
AMHERST NY
14226-1444
US

IV. Provider business mailing address

700 SWEET HOME RD
AMHERST NY
14226-1444
US

V. Phone/Fax

Practice location:
  • Phone: 716-836-7556
  • Fax: 716-837-2829
Mailing address:
  • Phone: 716-836-7556
  • Fax: 716-837-2829

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number030997-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number030997-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: