Healthcare Provider Details

I. General information

NPI: 1386086908
Provider Name (Legal Business Name): MELISSA MARIE NASTASI PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2013
Last Update Date: 07/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1046 HUDSON AVE APT. A
STILLWATER NY
12170-3432
US

IV. Provider business mailing address

1046 HUDSON AVE APT. A
STILLWATER NY
12170-3432
US

V. Phone/Fax

Practice location:
  • Phone: 518-588-7797
  • Fax:
Mailing address:
  • Phone: 518-588-7797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number24544
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: