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General NPI Number Information
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NPI Number | 1013203926
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Entity Type | Individual
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Provider Name | MELISSA K LUSTIC-LONG RDN, ATC, CSCS
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Gender | Female
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Dates
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Enumeration Date | 06/20/2011
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Last Update Date | 02/29/2024
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Provider Practice Location Address
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Address Line | 501 E 38TH ST MAC 202
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City | ERIE
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State | PA
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Zip | 16546-0002
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Country | US
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Telephone | 814-824-2084
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Fax |
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Provider Business Mailing Address
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Address Line | 501 E 38TH ST MAC 202
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City | ERIE
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State | PA
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Zip | 16546-0002
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Country | US
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Telephone | 814-824-2084
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | RTO000423
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number |
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License Number State |
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