MEDICARE: MRS. MELODY A ESPIRITU PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	016946-1	NY

General Provider Information

NPI Number	:	1710947429
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MELODY A ESPIRITU PT

Provider Business Mailing Address
First Line	:	16 WOODLEIGH CT
Second Line	:
City	:	HOLBROOK
State	:	NY
Zip	:	11741-2821
Country	:	US
Telephone Number	:	631-207-3632
Fax Number	:

Provider Business Practice Location Address
First Line	:	2805 VETERANS MEMORIAL HWY STE 8
Second Line	:
City	:	RONKONKOMA
State	:	NY
Zip	:	11779-7680
Country	:	US
Telephone Number	:	631-676-6324
Fax Number	:	631-676-6327

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/25/2006
Last Update Date	:	01/23/2022

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