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General NPI Number Information
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NPI Number | 1780146613
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Entity Type | Individual
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Provider Name | MELISSA LYNN VIRGILIO PTA
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Gender | Female
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Dates
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Enumeration Date | 04/01/2019
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Last Update Date | 04/01/2019
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Provider Practice Location Address
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Address Line | 105 MAIN ST STE 2
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City | NORTH TONAWANDA
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State | NY
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Zip | 14120-5313
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Country | US
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Telephone | 716-692-6388
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Fax | 716-692-1227
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Provider Business Mailing Address
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Address Line | 1328 MOLL ST
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City | NORTH TONAWANDA
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State | NY
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Zip | 14120-2230
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Country | US
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Telephone | 716-743-8077
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 011866-1
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License Number State | NY
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