Healthcare Provider Details

I. General information

NPI: 1033203153
Provider Name (Legal Business Name): MELISSA ANN HENZES-DOLHON MSPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

327 N WASHINGTON AVE SUITE 703
SCRANTON PA
18503
US

IV. Provider business mailing address

327 N WASHINGTON AVE SUITE 703
SCRANTON PA
18503
US

V. Phone/Fax

Practice location:
  • Phone: 570-346-1570
  • Fax: 570-346-1708
Mailing address:
  • Phone: 570-346-1570
  • Fax: 570-346-1708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT006376L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: